ORAL ANSWERS TO QUESTIONS

WALES

The Secretary of State was asked—

Economic Rebalancing

Karl McCartney: What assessment he has made of the effectiveness of steps taken to rebalance the economy in Wales since 2010.

Stephen Crabb: The previous Government were content to allow the British economy to become dangerously imbalanced with far too much reliance on the financial sector in London and the south-east. During this time Wales became poorer and fell to the bottom of the economic league tables, but we are determined to turn that around and achieve a stronger and more geographically balanced economy through a long-term plan, which is already starting to bear real fruit for Wales.

Karl McCartney: I thank my right hon. Friend for that answer—and offer him belated birthday wishes.
	With regard to the rural economy of Wales, I heard talk when I recently returned to St David’s university college in Llanbedr Pont Steffan of moves to re-open the Carmarthen to Aberystwyth railway line that passes through the Teifi valley. What effect does my right hon. Friend think this would have in reinvigorating the local rural economy, and might it help to rescue my alma mater from the parlous state various vice-chancellors since Lord Morris of Castle Morris have allowed it to descend to?

Stephen Crabb: I thank my hon. Friend for his question and his good wishes. I am a believer in investment in infrastructure. I recognise the important role investment infrastructure plays as a driver of economic growth. We have discussed at previous Wales Office questions the reopening of the Aberystwyth-Carmarthen line. He will be interested to know that I will shortly meet the campaign group Traws Link Cymru to discuss the business case for reopening the line and what support we can give, if appropriate.

Hywel Francis: I am sure the Secretary of State agrees that one of the best ways of rebalancing the economy is to ensure the interface between universities and the private and public sectors, and I know he recently visited my constituency and the new Swansea university campus at Crymlyn burrows. I am also sure he would wish to join me in congratulating
	the leader of Neath Port Talbot county borough council, which has developed a wonderful partnership with the university, and Councillor Ali Thomas on the honorary fellowship he will receive next week at Swansea university.

Stephen Crabb: I thank the hon. Gentleman for that question, and I absolutely do concur with his sentiments about the role local partners have played in taking forward the bay campus development. I was there on Friday, at the hon. Gentleman’s recommendation, and it is indeed a truly fine example of partnership-working. We know that success in the 21st century will belong to those economies that can harness knowledge and innovation, and having world-class university sites is part of that.

David Jones: Has my right hon. Friend noted the recently published report of South Wales chamber of commerce, which notes that confidence in the Welsh economy has been high throughout 2014 and that it looks to remain the same for 2015? Is he as pleased as I am that real business people in Wales are so enthusiastic and keen to talk up the Welsh economy, unlike the hon. Member for Pontypridd (Owen Smith), who devoted his recent article in the Western Mail to talking it down?

Stephen Crabb: I thank my right hon. Friend for that question, and he is absolutely right: the sentiment among businesses in north Wales, south Wales and west Wales is very confident and optimistic, and what they tell me every week as I criss-cross Wales talking to them is in stark contrast to the message we hear from the Opposition, who regularly now talk down the Welsh economy and the efforts of Welsh business.

Peter Hain: On the economy, how does the right hon. Gentleman respond to today’s research by the university of Oxford and the London School of Hygiene and Tropical Medicine that only a fifth of claimants who have had their benefits sanctioned and then taken away have found work? Surely this will not rebalance the economy or make it stronger, let alone make it just, and it is diabolically punitive.

Stephen Crabb: I have not seen that report so I am not going to get drawn into commenting on the specifics, but I have seen the latest figures for the performance of the Work programme in Wales, which should give us encouragement that we have a set of measures in place that is helping to bring down long-term unemployment.

Peter Hain: indicated dissent.

Stephen Crabb: The right hon. Gentleman shakes his head, but I encourage him to look at the figures for long-term unemployment in Wales: they are coming down yet again this month, which is positive news. There is much more to be done, but the emerging picture is a very strong and positive one.

Roger Williams: Tourism is very important to Wales, and to rural Wales in particular. It has been suggested that reducing VAT on visitor attractions and accommodation, as other EU
	countries have, would stimulate tourism and result in a higher tax-take. Does the Secretary of State agree with that view?

Stephen Crabb: I am familiar with the VAT arguments from the tourism sector. Of course these matters are the responsibility of the Chancellor of the Exchequer and he keeps them under review, but I would just point out to my hon. Friend the most recent tourism visitor figures, which showed about an 8% increase last year in international visitors coming to Wales. That has to be a good sign that the tourism sector is on the up in Wales.

Chris Evans: The new year has seen another rise in the tolls on the Severn bridge, and many businesses across Wales tell me that the bridge is now becoming a barrier to business and trade. Will the Secretary of State have urgent talks with the Chancellor of the Exchequer about reducing VAT on the tolls?

Stephen Crabb: The hon. Gentleman is right to talk about the burden that the increased tolls place on businesses and on visitors to Wales. We recognise that that is happening. They are, for example, a major burden on the small vans crossing the bridge. I have asked the Under-Secretary of State for Wales, my hon. Friend the Member for Vale of Glamorgan (Alun Cairns), to lead a body of work to look into the options for the Severn bridge, and he is having discussions with the Department for Transport. We also look forward to hearing the views of Members on both sides of the House.

Accident and Emergency Departments

Glyn Davies: What discussions he has had with Ministers of the Welsh Government on waiting times at A and E departments that serve patients from both sides of the England-Wales border.

Stephen Crabb: My ministerial colleagues and I regularly raise concerns with the Welsh Government about the provision of health care along the England-Wales border and we are reviewing the current arrangements to ensure that they meet patients’ needs.

Glyn Davies: When my constituents in Montgomeryshire need to attend A and E, they are taken either to hospitals in England, where 87% of patients are seen within four hours, or to hospitals in Wales, where, shockingly, the figure is only 63%. Does my right hon. Friend agree that the Welsh Government and the UK Government should work together constructively to deliver reforms to ensure that only genuine emergencies attend A and E?

Stephen Crabb: As ever, my hon. Friend makes a strong and constructive point. At this time of year, the NHS is facing severe pressures across the whole of the UK, and he is right to say that there is a disparity between the outcomes in Wales and those across the border in England. It is right that we should work together to address those disparities, but Welsh Government Ministers in Cardiff should be held to account for the decisions that have led to some of the problems.

Geraint Davies: Is the Secretary of State aware of the innovative medical centre at the end of Wind street in Swansea, which treats intoxicated people on the spot, freeing up ambulances, police and accident and emergency departments? Will he inform the Secretary of State for Health in England of the success of that venture, and suggest to him that similar facilities here could help to reduce the pressures caused by the removal of walk-in centres?

Stephen Crabb: I am not familiar with that facility, although I am familiar with Wind street—from what I have read, not from what I have experienced. However, we will certainly look at that project in some detail and I will raise the matter with Health Ministers.

Owen Smith: Since we last met, the Secretary of State has warned his Cabinet colleagues to mind their language when talking about the NHS in Wales. He said:
	“I want them to take care how they speak about health services in Wales…I don’t want to hear anyone talking about a second-class NHS in Wales”.
	Is he therefore disappointed that the Prime Minister has overruled him in continuing to bad-mouth the Welsh NHS?

Stephen Crabb: I am surprised to hear this from the hon. Gentleman. We on this side of the House are not shutting down the debate on, and scrutiny of, the performance of the NHS. We stand on the side of patients in England and in Wales, and it is quite wrong of him to act as some kind of cheerleader for the Labour party by seeking to shut down the scrutiny and the debate on the Welsh NHS.

Owen Smith: I take it from that answer that the Secretary of State is disappointed that the Prime Minister has overruled him. I believe that the Prime Minister has done that because talking about the Welsh NHS is his favourite way of distracting people’s attention from the failings of the NHS in England. Given that there is a crisis in hospitals near the border in Telford, in Shropshire, and in Cheltenham and Gloucester, where Welsh patients are traditionally sent, is it not now time for the Secretary of State to renew his efforts to get the PM to stop talking about Offa’s Dyke as though it were a line between life and death?

Stephen Crabb: On the subject of health, there are two apologies that we need to hear from the Opposition today. The first is an apology from the hon. Gentleman on behalf of the Welsh Labour party for the way in which its Ministers in Cardiff have run the Welsh NHS into the ground. The second is from the Leader of the Opposition for his disgraceful and inappropriate suggestion that the NHS should be “weaponised”.

Infrastructure Investment

Stuart Andrew: What assessment he has made of trends in the level of infrastructure investment in Wales since 2010.

Alun Cairns: We have been ambitious in our infrastructure investment plans to address the historic under-investment
	in Wales by previous Governments. We are enabling businesses in Wales to expand and explore new markets by investing in better train links, less-congested roads and faster broadband speeds.

Stuart Andrew: I thank the Minister for that answer. Given the commitment to fund the northern hub in full and the ambition for HS3 to improve connectivity right across the north of England, what is his Department doing to ensure that north Wales can take full advantage of those welcome developments?

Alun Cairns: My hon. Friend is right to highlight the significant infrastructure investment being made across the whole of the UK, but of course it is important that north Wales links into the rest of the UK. The fact that Crewe is the HS2 hub is important, and I look forward to hosting a transport summit in the next week or so to discuss how we best link north Wales with the rest of the UK.

Ian Lucas: What recent discussions he has had with the Secretary of State for Transport on investment in rail in north Wales. Will the Minister confirm that the UK Government have diverted funding previously allocated for the phase 1 and phase 2 modular rail signalling upgrade in north Wales to support investment in rail projects in south Wales?

Alun Cairns: I can categorically reject that. The UK Government are making significant investment in north Wales, at the Halton curve, and in south Wales, in the electrification of the main line right through to Swansea and in the valley lines and Vale of Glamorgan line services. I am proud of our record of electrifying railways in Wales. The previous Administration left us as one of the three nations across Europe without any electrified rail; Wales, sadly, was left with Albania and Moldova, and this Government are changing that.

Chris Ruane: Will the Minister congratulate the Welsh Government on providing funding for infrastructure investment in Rhyl? They have provided £28 million for new housing in Rhyl; £22 million for a new community hospital; £10 million for a new harbour; £25 million for a new Rhyl high school; and £12 million for flood defences. Will he also condemn the coalition Government, who have closed down Rhyl county court, Rhyl Army recruitment centre and Rhyl tax office, with the Crown post office possibly being relocated out of Rhyl?

Alun Cairns: The hon. Gentleman is somewhat selective in the data he shares. I am proud of the infrastructure investment record of this Government; he failed to mention the north Wales prison and the Halton curve, as well as the investment across the whole of Wales, not only in the north.

Jonathan Edwards: In recent months, I have been working with the communities of Salem, Cwmdu, Talley and Pumsaint, which have been without landline provision while waiting for damaged lines to be repaired. Communication problems have been exacerbated by a lack of mobile coverage,
	so will the Minister ensure that mobile not spots in Carmarthenshire benefit from the recently announced investment in mobile infrastructure?

Alun Cairns: I am grateful to the hon. Gentleman for raising that important issue. Openreach and British Telecom need to get on top of replacing those lines when they fall because of adverse weather. Let me also congratulate the Secretary of State for Culture, Media and Sport on the innovation he is showing in trying to close those not spots by using both private money and the mobile infrastructure plan, which will make a major difference in these areas.

Dairy Industry

Mark Williams: What steps the Government are taking to support the dairy industry in rural Wales.

Stephen Crabb: The Government are very aware of the severe pressures currently facing the UK dairy sector. I have discussed the situation in Wales with my ministerial colleagues, as well as with key stakeholders, including numerous dairy farmers. There are major short-term global factors pushing down prices, and we are calling on banks, supermarkets and major processors to show flexibility and understanding at this time.

Mark Williams: I thank the Secretary of State for that answer. We all understand the global challenges facing the industry, but will he urgently speak to his Department for Business, Innovation and Skills colleagues about extending the role of the Groceries Code Adjudicator to the whole supply chain—to all dairy producers—and, crucially, enacting the adjudicator’s power to fine? The next review of the role is not expected until 2016, and many of our farmers will not be functioning as farmers unless we have urgent action now.

Stephen Crabb: First, I commend the work my hon. Friend does on the dairy sector in Wales; he is a powerful voice on behalf of dairy farmers in his constituency and throughout Wales. We strongly support the work of the Groceries Code Adjudicator. Its jurisdiction is currently limited, but a review will take place next year. I take my hon. Friend’s point about the short-term pressures, so we look forward to receiving information and updates from him on action we can take.

Elfyn Llwyd: As a Member representing Pembrokeshire, the Secretary of State will be well aware that the dairy industry in Wales still contributes about 10% to the whole of the UK’s production, but that since 1999 its level has fallen by 51%. Will he look at yesterday’s report by the Select Committee on Environment, Food and Rural Affairs, which says exactly what the hon. Member for Ceredigion (Mr Williams) says: give the adjudicator greater teeth to tackle unfair pricing?

Stephen Crabb: I thank the right hon. Gentleman for his question, and we are looking exactly at that report. A very severe short-term crisis faces the dairy sector at this time. Nobody pretends that expanding the role of the adjudicator will fix the global problems—big market
	challenges need to be addressed—but we are doing everything we can to work with the dairy industry and protect the supply base.

Elfyn Llwyd: On the market challenges that the right hon. Gentleman refers to, what steps is he taking to urge his Government to work with the Welsh Government to implement policies we have suggested—for example, the dairy equivalent of Hybu Cig Cymru to market Welsh milk, the use of rural development funding to develop supply chains to counteract volatility, and procurement in the local Welsh sector?

Stephen Crabb: The right hon. Gentleman might be surprised to hear that we do follow the policy recommendations of Plaid Cymru and I have looked at the recommendation for that new body. When huge global imbalances are putting such severe pressure on dairy farmers throughout Europe, reaching for a bureaucratic solution and setting up a new quango probably will not make that much difference, but we will look at the proposal in further detail and have that discussion.

James Gray: With dairy prices at 20p a litre, First Milk collapsing last week and the discount supermarkets cutting prices day by day, it is hardly surprising that one dairy farmer goes out of business every 10 days. Does the Secretary of State agree that in addition to the efforts of the EU and national Government, we need to see far more action from the Welsh Government? There is a great deal they could do to support Welsh farmers, as well as farmers in North Wiltshire.

Stephen Crabb: I thank my hon. Friend for that question and make two points in response. First, First Milk did not collapse last week. It faces some pressures and there are specific impacts for dairy herds, but that co-operative is still very much functioning. Secondly, on the Welsh Government, we work constructively and co-operatively with them on agriculture issues.

Nia Griffith: The Secretary of State rightly recognises the severe crisis in the dairy industry, so with the Environment, Food and Rural Affairs Committee’s dairy price report criticising the grocery adjudicator’s role as too narrow and left toothless by this Government’s failure to set the level of fines that she can impose, will he now act with a sense of urgency, push for an immediate review of the adjudicator’s role and give that assurance to Welsh farmers?

Stephen Crabb: I am surprised by the tone that the hon. Lady takes. Under the Government that she supported, no progress whatever was made on implementing a code of practice or an adjudicator. As a Government we have been taking forward these measures. We will look at the specific recommendations of the Select Committee report, but we will take no lessons from the Labour party on the dairy sector.

Michael Fabricant: My right hon. Friend will know that independent grocers such as Spar in Tywyn in Gwynedd stock Welsh milk, which is clearly marked with y ddraig goch—the red dragon.
	What steps can he take to ensure that people in Wales drink Welsh milk rather than European milk, which will stimulate the market and support Welsh farmers?

Stephen Crabb: My hon. Friend is right. Welsh produce is the best in the world, and when it is labelled as such it gives consumers powerful signals, which they respond to. That is one of the ways in which we have been able to boost exports of Welsh agriculture produce in the past two years, but we will look at what further steps we can take to support labelled home-grown produce.

Welfare Reform: Social Housing

Ann Clwyd: What assessment he has made of the implications for the Government’s policies of the Auditor General for Wales’s report on “Managing the Impact of Welfare Reform Changes on Social Housing Tenants in Wales”, published in January 2015.

David Hanson: What recent estimate he has made of the number of households in Wales that have received a reduction in benefits since the introduction of the under-occupancy penalty.

Mark Tami: What assessment he has made of the implications for the Government’s policies of the Auditor General for Wales’s report on “Managing the Impact of Welfare Reform Changes on Social Housing Tenants in Wales”, published in January 2015.

Alun Cairns: This Government will not shy away from the financial and social responsibility of reforming the way in which housing benefit is allocated. There are no plans to change Government policy following the report from the Auditor General for Wales. We plan to use this report to support local authorities to respond better to local needs.

Ann Clwyd: As the Minister will know, there has been a large number of Government reports on the Government’s welfare policies. A Sheffield Hallam university report, for example, shows that the south Wales valleys will experience a £430 million cut in income, endangering 3,000 local jobs as a direct result of Tory welfare reforms. Is not the Minister ashamed?

Alun Cairns: The report that the right hon. Lady mentions is an important contribution to the debate, but it focuses on only one element of Government policy. It does not take into account the wider package of welfare reform—something that the previous Administration, sadly, shied away from. This Administration will not do so, because of the important need to tackle Government finances.

David Hanson: The 1,500 people in Flintshire who are impacted by the bedroom tax face no choice but to cut their incomes, which are already low, because there are no properties available. Will the Minister tell me how many two-bedroom and one-bedroom properties are available in Flintshire today?

Alun Cairns: The right hon. Gentleman raises an important point because the number of new social properties built in Wales over the past three years is, proportionately, far fewer than the number built in England over the same period. The Welsh Government have a responsibility to deliver in that area. The Wales Audit Office report also highlights the fact that 47% of tenants had no advice given to them on how better to manage the spare room subsidy and the obligations that it would bring.

Mark Tami: Will the Minister explain why it is right to force disabled people out of a home and into a smaller property—should one exist in the first place—rip out all the adaptations that have been made to that property and, presumably, put new ones into a second property? Apart from being cruel, how can such action possibly be cost-effective?

Alun Cairns: This Government have made additional money available through the discretionary housing payment to help individuals facing difficult circumstances. Only three out of 22 local authorities in the whole of Wales—Cardiff, Caerphilly and Conwy—applied for additional discretionary housing payments. The hon. Gentleman’s local authority did not do that. Let us be clear: the roots of the removal of the spare room subsidy lie deeply in the Labour Benches, because it was a Labour Administration who took it away from the private-rented sector. We are merely extending that principle to the social-rented sector.

Hywel Williams: My own local authority runs a useful forum for local agencies to plan a response to the bedroom tax, but its work is bedevilled by a lack of certainty over central Government support through the discretionary fund. Will the Minister prevail on his colleagues to give more certainty to future funding, which would help our work?

Alun Cairns: The discretionary housing payment is completely flexible and local authorities should use their discretion to see that it is used in the best way. The Wales Audit Office report provides excellent data and highlights some authorities such as Caerphilly and Cardiff that provide excellent practice and support their tenants in meeting the obligations of the spare room subsidy. After all, it is about returning the long-term unemployed back to the workplace, as that offers them the best opportunities and the best prospects.

High-tech Sector

Stephen Mosley: What assessment he has made of the level of growth in the high-tech sector in Wales since 2010.

Stephen Crabb: Wales has the potential to be a beacon of hi-tech excellence and innovation. Since 2010, thousands of new jobs have been created in the advanced manufacturing, ICT and life sciences sectors. The growth in those sectors is contributing to the rebalancing of our economy, which is so vital to future economic success.

Stephen Mosley: Does my right hon. Friend agree that it is remarkable that half the world’s mobile phones contain wafer semi-conductor technology that has been made in Wales?

Stephen Crabb: My hon. Friend is exactly right. Remarkable transformations are occurring inside the Welsh economy. Much more work needs to be done, but the picture is a positive one. That view stands in stark contrast with what the Labour party would have us believe, as it consistently—week in, week out—talks down the achievements of Welsh business.

Shared Services Jobs

Paul Flynn: What recent discussions he has had on increased shared services jobs in Gwent.

Alun Cairns: The Wales Office continues to hold discussions with the Ministry of Justice on the future of the Shared Services Connected Limited offices in Newport. The Justice Secretary has been clear that he would not support any proposals to offshore jobs from Newport.

Paul Flynn: The city of Newport has provided a splendid successful habitat for thousands of civil service jobs. Will the Minister renew his efforts to ensure that shared services, which were pioneered in Newport, are now strengthened and recognised as centres of excellence?

Alun Cairns: I am grateful to the hon. Gentleman for raising that issue. It is quite obvious that the pooling of the expertise and experience in Newport provides the shared services facility a great opportunity to try to attract work from both the private and public sectors, and we are determined to do what we can in that area.

Anti-Semitism

John Mann: What assessment he has made of the prevalence of anti-Semitism in Wales.

Stephen Crabb: Incidents of religious and racial hatred are thankfully very low in Wales. But as we approach Holocaust memorial day, it is right that we look again at the efforts we are making to prevent such incidents and to say with a clear and united voice that anti-Semitism and all forms of racial and religious hatred are not compatible with the freedom values that are cherished by the people of Wales. [Interruption.]

Mr Speaker: Order. This question is about Holocaust memorial day and the scourge of anti-Semitism. The House should listen to the question and to the answer.

John Mann: Thank you, Mr Speaker. The Jewish community across the whole of the United Kingdom is feeling under increasing threat. Will the Secretary of State ensure that the part of the United Kingdom that he is responsible for is as vigilant and as supported as every other part of the United Kingdom, so that his Jewish community can feel that it has our support?

Stephen Crabb: I thank the hon. Gentleman for the question. He is exactly right: no member of the Jewish community anywhere in the UK should have to live in fear. He may be interested to know that tomorrow I shall be meeting Rabbi Michael Rose in Cardiff, to talk about those concerns as they affect Wales.

Jonathan Evans: Will my right hon. Friend take the opportunity to remark not only upon Rabbi Michael Rose, but also upon the work done by Mr Saleem Kidwai, Secretary General of the Muslim Council of Wales, who has been working so very hard in Cardiff for good community relations for many years?

Stephen Crabb: My hon. Friend will also be interested to know that I am meeting the Muslim Council of Wales tomorrow. We had a remarkable and powerful demonstration of unity on the Sunday evening after the Paris attacks, when Rabbi Rose and the Muslim Council of Wales leader stood hand in hand, in unity, supporting freedom values in Wales.

PRIME MINISTER

The Prime Minister was asked—

Engagements

Siobhain McDonagh: If he will list his official engagements for Wednesday 21 January.

David Cameron: This morning I had meetings with ministerial colleagues and others. In addition to my duties in this House, I shall have further such meetings later today.

Siobhain McDonagh: Niluk is seven and he has autism. He desperately needs security and routine, but high London rents and insecure tenancies mean that he and his devoted family have moved four times in 18 months. As a result, he has had a breakdown and been admitted to hospital. Does the Prime Minister agree that insecure six-month private tenancies are no place for a family with children, and particularly not for children with autism?

David Cameron: I agree with the hon. Lady about how important it is that people do have security, particularly when they are looking after disabled children and they need that help. That is why we have been encouraging longer-term tenancies alongside the standard six-month tenancies, and we want to see those developed in the market.

Robert Jenrick: First they sold our gold reserves at a record low and then they tried to freeze our energy prices at a record high. Does not this latest display of economic illiteracy confirm that only this Government can prevent us, to be blunt—

Michael Ellis: James Blunt.

Robert Jenrick: James Blunt. Does not that confirm that only this Government can prevent us from returning back to bedlam?

David Cameron: I think I caught some of that, although I may need to buy the album to get the rest of it, but the point is a good one. The Opposition’s policy of freezing energy prices at the top of the market would be denying the price cuts that are now coming through to customers around this country. But the key to all this is to stick to our long-term economic plan, which again today is seeing unemployment fall and the number of people in work rise to record levels—something which I am sure we are going to welcome right across the House of Commons.

Edward Miliband: Let me start by saying, on the Iraq inquiry, that it was set up six years ago and I agree with the Prime Minister that it should be published as soon as possible.
	On the economy, as the election approaches, can the Prime Minister confirm that we now know this will be the first Government since the 1920s to leave office with living standards lower at the end of the Parliament than they were at the beginning?

David Cameron: First of all, let me agree with the Leader of the Opposition that we want to see this Iraq inquiry published promptly, but let me make this point. If everyone in this House, including Opposition Members, had voted to set up the Iraq inquiry when we proposed, it would have been published years ago. So perhaps he could start by recognising his own regret at voting against the establishment of the inquiry.

Edward Miliband: The inquiry was established six years ago, after our combat operations had ended, and frankly, my views on the Iraq war are well known and I want this inquiry to be published.
	I notice that the Prime Minister did not answer on the economy. Families are £1,600 a year worse off. He said in his 2010 manifesto that living standards would rise. Can we therefore agree that Tory manifesto promises on living standards are not worth the paper they are written on?

David Cameron: First of all, let us be clear: the right hon. Gentleman voted again and again and again against establishing the inquiry—but, as ever, absolutely no apology.
	Let me deal very directly with living standards and what is happening in the economy of our country. The news out today shows a record number of people in work and a record number of women in work. We are seeing wages growing ahead of inflation, and we are also seeing disposable income now higher than in any year under the previous Labour Government. As for the right hon. Gentleman’s figure of £1,600, it does not include any of the tax reductions that we have put in place again and again under this Government. That is the truth. The fact of the matter is that he told us there would be no growth, and we have had growth; he told us there would be no jobs, and we have had jobs; he told us there would be a cost of living crisis, and we have got inflation at 0.5%. He is wrong about everything.

Edward Miliband: The Prime Minister has raised taxes on ordinary families, he has raised VAT, and he has cut tax credits. The reality is that people are worse off on wages and they are worse off on taxes under this Prime Minister.
	The Prime Minister thinks everything is hunky-dory. Did he even notice this week the report that came out that said that half of all families where one person is in full-time work cannot make ends meet at the end of the month? You can work hard and play by the rules, but in Cameron’s Britain you still cannot pay the bills—that is the reality.

David Cameron: I study every report that comes out. The right hon. Gentleman is referring, of course, to the Rowntree report, which says that
	“the risk of falling below a socially acceptable living standard decreases as the amount of work in a household increases.”
	Under this Government, we have got over 30 million people in work, we have got the lowest rate of young people claiming unemployment benefit since the 1970s, long-term unemployment is down, and women’s unemployment is down. We are getting the country back to work. In terms of living standards, we have raised to £10,000 the amount of money people can earn before they start paying taxes, and people who are in work are seeing their pay go up by 4%. If we had listened to the right hon. Gentleman, none of these things would have happened. If we had listened to Labour, it would be more borrowing, more spending, more debt: all the things that got us into a mess in the first place.

Edward Miliband: The Prime Minister is the person who has failed on the deficit. This Prime Minister says—[Interruption.]

Mr Speaker: Order.

Edward Miliband: This Prime Minister says that we have never had it so good, and he is totally wrong. He does not notice what is going on because life is good for those at the top. Can he confirm that while every day people are worse off, executive earnings have gone up by 21% in the last year alone?

David Cameron: The right hon. Gentleman criticises me on the deficit—he is the man who could not even remember the deficit. Also, he has now had four questions and not a single word of welcome for the unemployment figures out today. Behind every single one of those statistics is a family with someone who can go out to work, who can earn a wage, and who can help give that family security. We are the party that is putting the country back to work; Labour is the party that would put it all at risk.

Edward Miliband: That is total complacency about one month’s figures when the Prime Minister has had five years of failure under this Government. Under this Prime Minister we are a country of food banks and bank bonuses; a country of tax cuts for millionaires while millions are paying more. Is not his biggest broken promise of all that we are all in it together?

David Cameron: Oh dearie me—you can see the problem that Labour Members have got. They cannot talk about the deficit because it is coming down. They
	cannot talk about employment because it is going up. They cannot talk about the economy because the International Monetary Fund and the President of the United States all say the British economy is performing well. So what are they left with? I will tell you, Mr Speaker. They have got an energy policy to keep prices high, they have got a minimum wage policy that would cut the minimum wage, and they have got a homes tax that has done the impossible and united the hon. Member for Hackney North and Stoke Newington (Ms Abbott) with Peter Mandelson. To be fair to the right hon. Gentleman, we learned at the weekend what he can achieve in one week in Doncaster, where he could not open the door, he was bullied by small children, and he set the carpet on fire—just imagine what a shambles he would make of running the country.

Edward Miliband: This is a Prime Minister—[Interruption.]

Mr Speaker: Order. It may well be that this session will take a bit longer, but questions and answers—[Interruption.] That is fine by me, but however long it takes, the questions and the answers will be heard.

Edward Miliband: I have to say to the Prime Minister: if he is so confident about leadership, why is he chickening out of the TV election debates?
	This is the Prime Minister who will go down in history as the worst on living standards for working people. He tells people they are better off; they know they are worse off. Working families know they cannot afford another five years of this Government.

David Cameron: Why don’t we leave the last word to the head of the International Monetary Fund? She is often quoted by the shadow Chancellor, who today seems to be having a quiet day: I can see why—because our economy is growing, and people are getting back to work. She said that the UK is
	“where clearly growth is improving, the deficit has been reduced, and where…unemployment is going down. Certainly from a global perspective this is exactly the sort of result that we would like to see: more growth, less unemployment, a growth that is more inclusive, that is better shared, and a growth that is…sustainable and…balanced.”
	That is the truth. Every day this country is getting stronger and more secure, and every day we see a Labour party weaker, more divided and more unfit for office.

Peter Tapsell: Does my right hon. Friend fully recognise the contrast in efficiency of the inquiries into the Crimean war and the Dardanelles campaign compared with the disgraceful incompetence of the Chilcot inquiry into widely held suspicions that Mr Blair conspired with President George W. Bush several months before March 2003, and then systematically sought to falsify the evidence on which action was taken?

David Cameron: I obviously bow to the knowledge of the Father of the House about the previous inquiries. I would say that the one thing all three inquiries have in common is that I am not responsible for the timing of any of them. The truth is that it is extremely frustrating that the report cannot come out more quickly, but the
	responsibility lies squarely with the inquiry team. It is an independent inquiry, and it would not be right for the Prime Minister to try to interfere with that inquiry, but I feel sure that when the report does come out, it will be thorough and it will be comprehensive. Let me repeat again: if the Labour party had voted for the inquiry when we first put it forward, the report would be out by now.

Mark Reckless: The Deputy Prime Minister dared to debate with Nigel Farage. Why won’t the Prime Minister?

David Cameron: I have made my views very clear: if we are going to have one minor party, we should have all the minor parties. When this happens, one point I will make is what Mr Farage said in 2012 about the NHS—the hon. Gentleman comes to the House week after week to talk about the NHS in Kent—when he said that
	“we are going to have to move to an insurance-based system of healthcare”.
	That is the UKIP policy—privatise the NHS; I say, “Never.”

David Ward: An estimated 13 million people—30% of those who should be eligible to vote—are registered incorrectly or are not registered at all on the individual electoral registration system. In the year of the election, will the Prime Minister ensure that the Government fully support national voter registration day on 5 February, and will he commit himself to taking part in Bite the Ballot’s leaders live event? It might help him in making his decision to know that the Greens have agreed to take part in that debate.

David Cameron: It is important that people register to vote. That is why local authorities have been given over £7 million to help in that process. Individual voter registration will help to cut out some of the fraud and some of the systems that were used in previous elections.

Mary Glindon: This week, Channel 4’s “Dispatches” did an excellent job of exposing the reality of life for millions of people who are in low-paid, part-time and insecure work. Can the Prime Minister not see that his failure to promote decent jobs with decent pay is still a fundamental problem for our economy?

David Cameron: If the hon. Lady looks at the figures, she will see that eight in 10 of the jobs that have been created in the last year are full-time jobs. The Labour party comes here trying to make a case, but I am afraid that all the evidence has moved away from it. Originally, it was said that no jobs would be created. We now see more people in work than ever in our history. Then we were told that all the jobs would be part time. We now see that the majority of the jobs are full time. Then we were told that the jobs would not pay more than inflation. We now see wages rising ahead of inflation. Of course, that is helped by the cuts in income tax that we have made to help people who are low-paid and take them out of income tax altogether. That is the programme
	that we are pursuing. There is not an ounce of complacency, because there is a lot more work to do, but we are on the right track.

Jessica Lee: This year marks the 800th anniversary of the signing of Magna Carta. Will the Prime Minister support the Magna Carta roadshow, a project that I am running in schools in Erewash to make all children aware of this important document and, more importantly, of the constitutional history of our great country and the rights and freedoms that we hold so dear?

David Cameron: I absolutely join the hon. Lady in making that point. This is an important anniversary, and it is important that this country and our Parliament commemorate it properly. We must teach children in schools how our constitution has evolved and what rights we have, because pride in those things is important in understanding what a precious jewel we have in a functioning democracy under the rule of law.

Andrew Gwynne: The target of a maximum two-month wait from an urgent referral for suspected cancer to first treatment for all cancers is being breached. Is there a bigger sign of his Government’s failure than the Prime Minister’s inability to uphold key rights for cancer patients that are enshrined in the NHS constitution?

David Cameron: It is vital that cancer patients get urgent treatment. Under this Government, half a million more people are getting referred for cancer treatment. That is why cancer survival rates are going up. Let me give the hon. Gentleman the figures for his own hospital area: 96.8% of patients with suspected cancer are being seen by a specialist within two weeks, which is an improvement on 2010; 100% of patients diagnosed with cancer are beginning treatment within 31 days, which is an improvement on 2010; and 94.8% of patients are beginning cancer treatment within 62 days of a GP referral, which again is an improvement on 2010. The reason we have been able to make those improvements is that we put resources into the NHS when the Labour party told us that that was irresponsible. We have also got rid of the bureaucracy in the NHS in England, which is why it is performing better than the NHS in Wales.

Richard Ottaway: I share the Prime Minister’s disappointment over the delay to the Chilcot report, particularly given that the issue in 2009 was whether it would be published in time for the 2010 election, let alone the 2015 election. Does the Prime Minister agree that the invitation of the Foreign Affairs Committee to Sir John Chilcot to give evidence to us, not to point the finger of blame, but to give him a chance to explain the reasons for the delay, should be accepted to ensure that this situation never happens again?

David Cameron: Obviously, my view is that when people are asked to appear in front of a Select Committee, and when they are public servants, they should try to meet that obligation. How that is processed is a matter for the House and my right hon. Friend’s Committee. The most important thing right now for Chilcot and his team is to get the report ready and ensure it can be published as soon as possible after the election.

Angela Smith: Last summer my constituent, Mr Kenneth Bailey, suffered a major stroke while out shopping. The emergency call was classed as a Red 2 priority, yet it took Yorkshire ambulance service an hour and four minutes to get to him. That is just one example of a crisis that is now nationwide. What will the Prime Minister do about that situation?

David Cameron: What we are doing for the ambulance service is ensuring that there are 1,700 extra paramedics, and we have put £50 million more into the ambulance service over the winter. I hope something that all sides of the House can unite over is that it would be completely wrong for the proposed ambulance strike to go ahead next week. I unreservedly condemn any attempts to go on strike and threaten our services, particularly at this time of heightened national concern, and I hope that members of the Labour party, irrespective of which union they are sponsored by, will do the same thing.

Charlie Elphicke: The Leader of the Opposition will not, but will the Prime Minister welcome the International Monetary Fund saying this week that Britain has the “fastest-growing advanced economy” in the world? Will he welcome today’s announcement that unemployment is falling in Dover, Deal and across Britain, and does he agree with President Obama that we “must be doing something right”?

David Cameron: I thought it was very kind of the President of the United States to make that point about doing something right, and the IMF is absolutely clear. It said:
	“The UK is leading in a very eloquent and convincing way in the European Union. A few countries, only a few, are driving growth:”.
	That is what the IMF thinks about the British and American economies. Obviously that is helping in Dover where the claimant count is down by 28% since the election, but we should not be satisfied until everyone who wants a job in our country is able to get a job in our country, and until our employment rate is the best in the G7. That is what I would define as achieving what we want, which is full employment in our country.

Toby Perkins: The Prime Minister’s crisis in the national health service has its roots in general practice, and the changes the Government made to GP pensions saw a huge number of GPs retire early. In my area in Chesterfield, 40% of places for the future recruitment of GPs are left vacant. How can we expect the country to recruit the number of GPs we need when so few of them have any confidence in the Prime Minister’s running of the national health service?

David Cameron: The figures show that 1,000 more GPs are working in the NHS today than when I became Prime Minister, and in the hon. Gentleman’s area there are 25 more GPs than in 2010. I agree that we need further changes to ensure that our GP and family doctor service works really well. Four million people already have access to seven-day opening at GP surgeries, and I want that expanded to the whole country. That is
	a step forward after the step back taken by the last Labour Government, who took GPs out of out-of-hours care altogether.

Bob Russell: The east of England helped boost the nation’s economic recovery, and we could do even more if the East Anglian rail manifesto was implemented. Will the Prime Minister encourage colleagues to fund that with modern rolling stock for the Greater Anglia main line, and infrastructure improvements through Essex?

David Cameron: I want to see real improvements in the Greater Anglia service, and the hon. Gentleman is right about the economy in the eastern region of our country, which has 224,000 more people in work compared with 2010. The Chancellor said in the autumn statement that we would provide funding for improved rolling stock, and as well as improvements in Essex we want to help achieve the Norwich in 90 campaign. We also want a service from Ipswich that will get to London in under an hour. That will take investment, but that is part of our long-term economic plan.

Diane Abbott: The delay in the publication of the Chilcot report is widely considered to be a scandal. Does the Prime Minister appreciate that it is important to find out exactly what has gone wrong? We have a major forthcoming inquiry into child sex abuse. The public would not understand if powerful people that might be named in that report are able to delay publication year after year, as seems to have happened with Chilcot.

David Cameron: I agree with the hon. Lady that it is important that the inquiries are done thoroughly and rapidly. My understanding is that there is no mystery in why it is taking so long. It is a thorough report. The people who are criticised in a report have to be given the opportunity to respond to all those criticisms. That is what is happening at the moment. From what I understand, I do not believe that anyone is trying dodge or put off the report—we all want to see it—but we have to go through the proper processes.
	Let me make one other point clear. There is no question of the report being delivered to me and of my deciding not to publish it before the election. The whole report will not reach the Prime Minister’s desk, whoever that is, until after the election.

Angela Watkinson: Will the Prime Minister join me in congratulating Havering chamber of commerce and industry and the Havering branch of Mind, which are coming together tomorrow evening in an event to promote employment opportunities for people with mental health problems?

David Cameron: I will certainly do so. It is right that mental health is getting a much higher political profile today than in the past. We have given mental health parity of esteem in the NHS constitution, but my hon. Friend is right that one of the key challenges is helping people with mental health conditions to get in to work. Business can do a lot more by engaging with the charities to help people in that situation.

David Winnick: As we know, next week it will be 70 years since Auschwitz was liberated by the Russians. Is it not important that, when issues such as Palestine are raised—I have raised it and will continue to do so—it should be no excuse for anti-Semitism, a murderous disease that took the lives of millions of innocent people during my lifetime?

David Cameron: I agree 100% with the hon. Gentleman in everything he says. Anyone who has been to Auschwitz—I went recently—cannot help but be struck by the appalling end that came of the hatred and prejudice fostered across Europe. The sight of all those children’s clothes, toys and bags, and human hair, stays with people for a very long time after they have seen them. Ensuring that the Holocaust Commission that we have established reports soon has all-party support. We will take that work forward and continue to ensure that young people in our schools can make the harrowing but very powerful trip to see Auschwitz for themselves.

Menzies Campbell: As someone who voted with his colleagues against the Iraq war, I have sought to follow the Chilcot inquiry very closely. May I tell my right hon. Friend that I am aware of no evidence that any witness has sought to alter the progress of the inquiry by delay? I am aware of reports of instances of illness, including in one case a severe illness, among members of the inquiry. After the experience of the Saville and Chilcot inquiries, is not the lesson that the proper template for future inquiries should be Leveson—judge-led, but with a strict timetable?

David Cameron: My right hon. and learned Friend makes a strong point in the stance he takes. I agree with him. I have not heard anything to say that anyone is trying artificially to delay the report. He is absolutely right about some of the things that have happened to the inquiry panel members, most notably to the most brilliant biographer of Churchill, Martin Gilbert. I am sure the best wishes of everyone in the House go to him. My right hon. and learned Friend makes the fair point that, as inquiries are set up, we should give more thought to trying to ensure they are completed in very good time.

Stephen Timms: The Prime Minister said that his policies would eradicate the deficit in this Parliament. Unfortunately, he was mistaken—a very large deficit remains. What is the reason, in his view, why his economic plan has fallen so far short?

David Cameron: We inherited from Treasury Ministers, including the right hon. Gentleman, the biggest deficit of any country in the western world. As a share of GDP, we have cut that in half. We have done that through a combination of reducing public spending, making sure we have responsible tax policies and strong economic growth. That is what we have delivered. All the way through, the Labour party’s proposals have been for more spending, more borrowing and more debt. They have not even got to base camp of working out why the deficit matters.

Gerald Howarth: As the Member privileged to represent the home of the British Army in Aldershot, which I can tell the Father of the House was established as a direct result of the inquiry into the Crimean war and the failures thereof, may I ask my right hon. Friend the Prime Minister to reassure me that press reports this morning about discussions on reducing the regular Army from the already low level of 82,000 to 60,000, are wholly unfounded and that, so long as he remains Prime Minister, no such cuts will be contemplated?

David Cameron: I can absolutely give my hon. Friend that assurance. Those ideas are absolutely not on the table. As long as I am Prime Minister, the regular Army will stay at its current size.

Pamela Nash: I very much welcome the reduction in UK unemployment announced this morning. I have to add, however, that that is not the case in my constituency, where unemployment has actually risen very slightly. I am sure the Prime Minister has that in his notes in front of him. For those who are in work, the value of their wages has dropped in the past year by 1.5%, while the wages of the Prime Minister’s constituents continue to rise above inflation. Is the Prime Minister proud that under his watch the poor continue to be poorer and the rich keep getting richer?

David Cameron: If we look at Scotland as whole, on the year unemployment is down by 20,000 and the rate of unemployment in Scotland is also down. The rate of unemployment in Scotland is lower than the rate of unemployment in, for instance, London, so the idea that this recovery is being felt only in the south of our country is simply nonsense. The hon. Lady mentions wages. Obviously, one of the most powerful things we can do to help people with the cost of living is to take them out of income tax. In Scotland, we have taken 23,000 people out of income tax altogether, and over 2 million people are benefiting from the personal allowance changes that have already helped people to the tune of more than £700 a year.

Glyn Davies: The dairy industry underpins the economy of rural Britain, including that of my constituency of Montgomeryshire. The dairy industry is currently in difficulty. Does the Prime Minister accept that the Government must consider all ways to bring stability to this important sector, including whether the powers of the Groceries Code Adjudicator should be extended and strengthened?

David Cameron: I very much agree with my hon. Friend. It is important that we look at how we can support Britain’s dairy farmers at a time of very low milk prices. This is an important industry for our country and I think there are a number of things we can do; first, make sure that Her Majesty’s Revenue and Customs is prepared to provide the time to pay to support our dairy farmers. There is more we can do in terms of leading exports for British food producers—I know the Secretary of State is very keen on that. Specifically on the Groceries Code Adjudicator, something we have established, it is time to make sure that that organisation
	has the power, if necessary, to levy fines so that it can get its will obeyed. I also think it is time to look at whether there are ways in which its remit can be extended to make sure it looks at more of this vital industry.

Gemma Doyle: West Dunbartonshire desperately needs a pay rise. A quarter of our children are living in poverty, and this Prime Minister’s policies are failing them and their families. A year ago, the Chancellor suggested that he wanted to see a £7 national minimum wage from this October. Will the Prime Minister tell me why his Government’s evidence to the Low Pay Commission makes no mention of this at all?

David Cameron: Our evidence to the Low Pay Commission says we need another increase in the minimum wage. It is only under this Government that we have seen a minimum wage increase ahead of inflation, which never happened while Labour was presiding over economic chaos. That is the truth. Let me explain to the hon. Lady. She will have to explain to her constituents why Labour’s minimum wage policy would actually cut the minimum wage in the next Parliament. That is how incompetent and useless those on the Opposition Front Bench are. The best thing we can do is to keep growing the economy, keep creating jobs and keep cutting taxes, because we are on track and the plan is working.

Philip Davies: There has been a spate of dog thefts across the Bradford district, where a rally has been held to bring people’s attention to the plight of Murphy, a husky stolen recently. It is very distressing for the owners and dogs concerned, who are devoted to each other. Some of these dogs are used in practice for dog fighting, and who knows what fate awaits some of
	the other stolen dogs? Will the Prime Minister use his good offices to draw attention to this problem and ensure that the authorities investigate these crimes and take them as seriously as any other crime?

David Cameron: My hon. Friend makes an important point. We are a nation of dog lovers—people are very attached to their pets—and it is appalling when they get stolen, particularly for the sorts of purposes he talked about. Obviously, the changes we have made on compulsory chipping should help, but my heart goes out to anyone who sees a much-loved pet taken from them.

Several hon. Members: rose—

Mr Speaker: Last but not least, I call Mr Nigel Dodds.

Nigel Dodds: As the Prime Minister looks back over his achievements in the past five years and considers what he might—or might not—be doing in the first few months of the next Parliament, and further to the question from the hon. Member for Aldershot (Sir Gerald Howarth), will he commit to maintaining defence spending at 2% of GDP to ensure that our commitments to our NATO allies are met and that our country is secure and strong at home and abroad?

David Cameron: We are one of the few NATO countries that do achieve 2% of spending on defence, and because of that, we will see, in the coming months and years, a defence equipment programme that is second to none in Europe: two aircraft carriers, new joint strike fighters, hunter-killer submarines and new frigates. We can see a strong defence industry, supported by our commitment that the defence equipment programme specifically should be protected.

Speaker’s Statement

Mr Speaker: In 2015, the Houses of Parliament, along with the people of the UK, commemorate two important anniversaries: 800 years since the sealing of Magna Carta in June 1215 and 750 years since the calling of the Simon de Montfort Parliament in January 1265. These historic events can be seen as marking the start of a journey towards our modern-day rights and representation. So this week, exactly 750 years since Simon de Montfort summoned that Parliament to meet in the chapter house of Westminster Abbey on 20 January 1265, is an important week for the House of Commons in particular.
	It was not the first English Parliament, and the Scottish and Welsh Parliaments have parallel histories, but, because it was the first Parliament in which representatives from towns were summoned, alongside the knights, it is seen as the earliest forerunner of the modern Parliament. I look forward to attending the commemorative events in Westminster Abbey tomorrow, together with Members of both Houses and, importantly, with Members of the UK Youth Parliament. Another important occasion takes place in February, when the four existing copies of the 1215 Magna Carta will be displayed in the House of Lords.
	This year sees other anniversaries too, including the 50th anniversary of the death of Sir Winston Churchill, the 200th anniversary of Waterloo and the 600th anniversary of Agincourt. We will also be marking the 20th anniversary of the Disability Discrimination Act, the 40th anniversary of the Sex Discrimination Act, the 50th anniversary of the first Race Relations Act and the 600th anniversary of the role of Serjeant at Arms.
	These will all be commemorated in a programme being organised jointly by both Houses of Parliament out of existing budgets. This programme of celebrations, entitled “Parliament in the Making”, is designed to raise awareness of our democratic heritage. Our programme aims to increase public understanding that Parliament is at the heart of our democracy and that its work matters to everyone. It aims to mark our history in innovative ways that are relevant to contemporary society.
	I hope that many colleagues will now have seen the first manifestation of that intent in the shape of the banners in Westminster Hall, which give fresh artistic interpretations of key moments in our 800-year journey. I know that colleagues will wish to play a full part in this programme—indeed, there have been hundreds of nominations from Members of Parliament for the schools flag project. Flags designed by schools from all the historic counties of the United Kingdom will fly later this year in Parliament square and at the national Magna Carta celebrations at Runnymede in June. There will be other opportunities to participate, too, with a number of lectures and public arts projects, as well as a major public celebration entitled “LiberTeas” on Sunday 14 June. Details are available on the parliamentary website.
	I am grateful—and I feel sure that all colleagues will similarly be grateful—to all the staff of both Houses who have worked hard and imaginatively to make these events possible, and to the Speakers' advisory group on the 2015 anniversaries, which has advised both the Lord Speaker and me on the programme. In particular, I am sure that the House would want me to thank the group’s Commons Chairman, the hon. Member for Mid Worcestershire (Sir Peter Luff) for the energy and wisdom that he has brought to the task.
	It is a happy coincidence that these significant anniversaries fall in an election year. It is less reassuring to note the many challenges to democracy around the globe, recently made manifest in the horrific and devastating events in Paris.
	Parliament is not everything about our democracy, but our democracy is not worth anything without this Parliament. That is why it has rightly been at the centre of national attention throughout the centuries and why it must continue to be so. The contest for influence here has ranged from Cromwell to the Chartists, Lords to the Levellers and Speakers to suffragettes. Importantly, it is not only—or even mainly—a matter of decisions imposed from the top down, but of pressure from the bottom up, that has shaped our institution to be what it is today. While the nature and size of the electorate represented here have changed enormously over the generations, the principle of representation has remained remarkably consistent across all that time. It is that principle that, very properly, we commemorate and celebrate this year.

Points of Order

Peter Luff: On a point of order, Mr Speaker. May I thank you for those kind words and express my own appreciation to you and to the Lord Speaker for your enthusiastic endorsement of the whole “Parliament in the Making” programme? May I also endorse what you said about my colleagues on the Speakers' advisory group and, above all, the energetic team, led by Caterina Loriggio, who are working so hard to deliver the programme?
	The banners now hanging in Westminster Hall are a powerful reminder to Parliament that defending the rights of all the people is one of the most important things we do. So finally, Mr Speaker, through you, may I invite colleagues across the House to seize the many opportunities provided and so help us to achieve our objectives of inspiring people about the 800-year history of our rights and representation, educating a new generation about that history and encouraging participation in civil society and our democracy?

Mr Speaker: I repeat my thanks to the hon. Gentleman for his work and my appreciation of his courtesy in respect of everybody else’s efforts. Thank you.

Edward Leigh: Further to that point of order, Mr Speaker. I have done a bit of research, and have established that the first Speaker was Sir Thomas Hungerford, who took his place in your Chair in 1377. I am afraid that means that you are only 638 years old, Mr Speaker, although it does not feel like that to those of us who sit under your speakership. It also means that in 12 years we shall have another happy anniversary, and we all wish you well for that, too.

Mr Speaker: I am extremely grateful to the hon. Gentleman, and I thank him for what he has said.

Jason McCartney: On a point of order, Mr Speaker. Given your understanding and co-operation on behalf of the few, and speaking as a former RAF officer, may I highlight another anniversary—the 75th anniversary of the battle of Britain?

Mr Speaker: The hon. Gentleman has done so, and he has done so with his usual eloquence—and very succinctly.
	If there are no further points of order, we shall move on to a matter of great importance to the House: a Division correction. I have received a report from the Tellers in the Aye Lobby about the Division on Trident renewal that took place at 6.59 pm yesterday. They have informed me that the number of Members who voted Aye was erroneously reported as 35 instead of 37. The Ayes were 37, and the Noes were 364.

Yemen

Keith Vaz: (Urgent Question): To ask the Secretary of State for Foreign and Commonwealth Affairs if he will provide an answer to an urgent question of which he has been given notice.

Tobias Ellwood: I have been asked to reply.
	As the House will be aware, violence in Sana’a has escalated. Heavy clashes broke out yesterday between the Houthis and Yemeni security forces, and the situation is evolving rapidly. Although a fragile ceasefire was negotiated, its implementation has been, at best, partial. The presidential office and President Hadi’s home are now under Houthi control.
	I am deeply concerned about the situation in Yemen. I urge all parties to step back from conflict in Sana’a, Ma’rib and other parts of the country, and to ensure that the ceasefire holds. Those who use violence, the threat of violence and abductions to dictate Yemen’s future are undermining the security of all its citizens and eroding the political progress that has been made since 2011.
	The UK is playing an active role in encouraging all parties to work peacefully together to implement and enforce a ceasefire and return to dialogue within the framework of the Gulf Co-operation Council initiative, the outcomes of the national dialogue conference, and the peace and national partnership agreement reached between President Hadi and the Houthi leadership last September. The PNPA is a framework for peaceful political transition, and I call on all parties to work through the cross-party National Authority—which is effectively a national assembly—to implement the agreement, which should include the establishment of a new constitution.
	I spoke to our ambassador in Yemen yesterday. The British embassy in Sana’a remains open and all our staff are safe, but we are obviously keeping the situation under close and active review. Since March 2011, we have advised against all travel to Yemen.

Keith Vaz: I thank the Minister for his answer, and thank you, Mr Speaker, for granting the urgent question.
	As the Minister has said, Yemen is on the brink of an implosion that threatens to shatter the entire region. The Shi’a Houthi rebel group has encircled, bombed and stormed the presidential palace. When the House debated the death of UK-born hostage Luke Somers in December last year, all the warning signs of an impending crisis were there. No one doubts the Government’s commitment to providing aid for Yemen—last week I met the Department for International Development Minister, the right hon. Member for New Forest West (Mr Swayne), to hear what they were doing—but that aid is not enough. There are troops in the streets, and thousands have already died in sectarian violence during this and last year. The country is of such strategic significance that we cannot afford to allow it to fail.
	As the House knows, I was born in Yemen. I left with my mother and sisters in 1965, but I have returned repeatedly in my capacity as chair of the all-party group on Yemen, and I personally cannot say nothing while Sana’a burns.
	This is now the time for urgent action. It is an important moment in Yemen’s history. What additional support are we prepared to provide to the Government of Yemen? Yemen is a key ally in the region against extremism and terrorist groups, including those responsible for the attacks in Paris. There is an immediate and extreme danger for British citizens in Yemen, who are estimated to number 2,200. That includes our embassy staff. The US has deployed naval warships to evacuate the US embassy, so what measures are we taking? Will we evacuate our personnel?
	Although the UK Government have a good record of providing assistance to Yemen, I fear that our friends and allies do not recognise the importance of the region. What steps is the Minister taking to try to encourage the Friends of Yemen to do much more, specifically Saudi Arabia and Oman? We can all appreciate the work done by the former Foreign Secretary, the right hon. Member for Richmond (Yorks) (Mr Hague), the Prime Minister and others in assisting Yemen during and after the Arab spring. I also applaud the appointment by the Prime Minister of the right hon. Member for Rutland and Melton (Sir Alan Duncan), who I know cares about the country, as his envoy. We need to act. Our focus is on Syria and Iraq, but we cannot allow Yemen to collapse.
	Finally, al-Qaeda in the Arabian Peninsula, the group that trained and directed the Charlie Hebdo terrorists, has already exploited the political instability in Yemen. This is where some international terrorists are trained. If Yemen falls, the front line of the conflict will be the streets of London, Birmingham and Leicester. We simply cannot allow this beautiful country to become a haven for terrorism and violence. To fail to act would be a betrayal not just of the Yemeni people but of the bonds of history that bind our two countries together.

Tobias Ellwood: I pay tribute to the right hon. Gentleman, with his personal connections to the country, for the expertise he brings to the House and for his leadership as chair of the all-party parliamentary group. I appreciate the urgency of the question, but we were not going to make a statement because the situation continues to be fluid. What we say today could well be outdated by tomorrow. The Prime Minister is under house arrest, the President has moved to the south and the leader of the Houthis made a 75-minute statement on television yesterday but did not declare that he was now the leader of Yemen. The situation remains extremely fluid.
	The right hon. Gentleman sums up the situation accurately and I agree with him. Strategically, Yemen is an important country for Britain. We have historical connections with it and we have devoted much work to it. I am pleased that he has had the opportunity to speak to my counterpart in DFID about the work we are doing to provide political stability and economic direction as well as improvements to security. He mentions
	the attack on
	Charlie Hebdo
	, and that is a reminder to all countries—not just those in the region but those further off, including Britain—of how terrorism and extremism can leave a region and move much closer to home. We heed his words very carefully.
	The right hon. Gentleman mentioned the United States embassy. It is located in a different part of the city from ours and has its own evacuation programme. Each embassy must make its own judgment on what is necessary. The number of Britons operating in Yemen is extremely low and there are good connections between the embassy and those who choose to go against the travel advice I mentioned earlier.
	The right hon. Gentleman also mentioned the Friends of Yemen. Let me elaborate on that. That is the organisation run through the United Nations that is co-chaired by Saudi Arabia and Britain. It comprises more than 40 countries and the past couple of years up to $8 billion has been granted to Yemen to help with political, economic and security reform. We must obviously assess the changes that have taken place, but the peace and national partnership agreement is critical. That is a document that has been signed by the President and agreed by the Houthis and given the sentiment expressed in the 75-minute speech I mentioned, we hope that all parties can come around the table and work towards a peaceful solution.
	Finally, the right hon. Gentleman is absolutely right that al-Qaeda in the Arabian Peninsula is a spoiler and an example of extremism. The worry about the Ma’rib region, which the Houthis are now pushing into, is that there are pockets of al-Qaeda and there will be a conflict of extremism there unless there is an agreement. That is what we are now working towards.

Richard Ottaway: I welcome the question of the right hon. Member for Leicester East (Keith Vaz) and agree with the sentiment contained in it, as well as with the Minister’s response. I welcome his tone. The Minister says that our embassy remains open, but can he assure me that if the situation deteriorates measures will be taken to get our staff out and to protect them? Finally, there are media reports about a connection between the Charlie Hebdo attack and the situation in Yemen. Is the Minister in a position to comment further on that?

Tobias Ellwood: I am grateful to the Chairman of the Select Committee on Foreign Affairs for his question and the manner in which he asks it. He asks at what point we should evacuate the embassy. I will speak to the ambassador later today and evacuation plan is already in place, but it has not yet been activated. I will speak to the ambassador and ensure that the House is updated if the situation changes. He asked about the connections between al-Qaeda and the Charlie Hebdo attacks. It has been reported that there is a link and that the individuals were trained in Yemen. The French authorities are working on that and we are working closely with them to provide support in their endeavours.

Jeremy Corbyn: I thank the Minister for his response to the urgent question. Will he say something about the involvement of Saudi Arabia, Saudi Arabia’s military operations and any possible
	incursions into Yemen? Will he assure us that there is no possibility of any British armed forces being sent to the area, either?

Tobias Ellwood: Saudi Arabia and many of the countries that neighbour Yemen have an interest in the country, particularly Saudi Arabia, which, as I have said, is co-chair of the Friends of Yemen. I will speak to the embassy in the next couple of days to take stock of the changes that are taking place. I will ask about any military engagement that might take place, but as I have said we call for all parties, whether they are in the country or not, to come together and return to the peace and national partnership agreement, to which the Saudi Arabians have also signed up.

Alan Duncan: I cannot praise too highly the bravery and work of our ambassador, her embassy personnel and DFID staff. I spoke last night to the Yemeni Prime Minister, who was trapped and besieged, and the danger is that Yemen will end up without a legitimate Government and will become ungoverned anarchic space, leading to unchecked terrorist training, civil war, proxy conflict and humanitarian disaster. The right hon. Member for Leicester East (Keith Vaz) is absolutely right to highlight the importance of this country. Will the Minister confirm that the United Kingdom will, as a matter of urgency and as a top diplomatic priority, work with all our Gulf allies, the United States and the United Nations to try to haul Yemen back from the brink of the cliff edge on which it rests?

Tobias Ellwood: I thank the Prime Minister’s envoy to Oman and Yemen, particularly as he has kept me up to date over the past few days with his contacts and his thoughts and advice. He is absolutely correct that we do not want ungoverned space to develop in Yemen and with all the activities and challenges going on in the middle east, this area does not have the same profile as others. It has now moved up the agenda by virtue of this urgent question and it is important that we give assistance to the country to ensure that all parties come together, not only those in the country but those in the United Nations and the United States, to work towards a peaceful solution.

John Spellar: As we have already seen, the situation in Yemen is a matter of considerable concern for Members on both sides of the House and for many of our citizens of Yemeni heritage in long-established Yemeni communities, including in the borough of Sandwell. As the security system in Sana’a has worsened, there have been reports of Houthi rebels shelling the President’s home in Sana’a and seizing control of the presidential palace.
	The UN Security Council has rightly condemned these latest attacks, and clearly the priority must be to resolve this situation peacefully and quickly. In the wake of this sustained violence, may I first ask the Minister what emergency provisions have been put in place to help ensure the safety and security of British citizens still based in Yemen? We know there are many brave and committed NGO workers in Yemen, as well as a dedicated team of UK Government officials. Their work continues to be vital and their commitment to the country is long standing, so can the Minister give the
	House an assessment of the number of British citizens potentially affected by the recent violence? Will he also set out, as far as he can, what contingency arrangements are in place, should there be an urgent need to evacuate British citizens and personnel from the affected areas?
	A statement adopted by all 15 members of the UN Security Council made clear that President Hadi was “the legitimate authority” of the country. He was reported to be inside his house when it was shelled. The Minister said that the President is now under house arrest. Can the Minister offer any further assurances about the President’s safety and whereabouts?
	Clearly, as well as restoring calm to the country, the implications of renewed violence in Yemen are far-reaching given al-Qaeda in the Arabian Peninsula has established it as their base, especially in its efforts to destabilise Saudi Arabia. In light of this, can the Government set out what long-term support is being offered to the Yemeni authorities to help counter the threat of AQAP, and how is this support being affected by the recent attacks? An end to the violence is the urgent priority, and we know that all sides have agreed to ceasefires in the past, but given that today’s attacks followed the breakdown of a ceasefire that had been in place less than 24 hours before, what can international partners do to try and encourage a return to ceasefire talks, and also to secure more lasting agreements?
	Yemen faces not only a worsening security situation, but continuing political and economic challenges. Recent progress towards a political transition, including drafting a new constitution and holding a referendum as well as general elections, were welcome, but even this limited progress is now at risk of being undermined by these latest attacks. As the Minister said, the UK is chair of the Friends of Yemen group, so what steps will the UK Government be advocating to focus all parties’ efforts on the need to secure an effective political transition? UN Security Council resolution 2140 was unanimously adopted in February last year and included a sanctions committee responsible for implementing the restrictive measures under that resolution. Can the Minister confirm whether the committee has published any new recommendations or guidance in the light of the recent attacks?
	The international community must remain determined to help achieve the transition that is needed within the country, while the UK Government will also have our support in doing what is necessary to ensure the protection of British citizens in the affected areas.

Tobias Ellwood: First, may I thank the right hon. Gentleman, the Opposition spokesman, for the cross-party support on this? He speaks about the UK diaspora. It is important that it is informed and kept up to date with what is happening in the country. He also spoke about the role of the UN, and I wish to put on record my thanks to the UN special representative to the Secretary-General, Jamal Benomar, who I have met a number of times, including at the UN General Assembly in September, when UN resolution 2140, which the Opposition spokesman referred to, was agreed.
	There is, as I have mentioned, a well-rehearsed evacuation plan. The number of Britons based in Yemen is minimal, and the embassy assures me that plan is ready to be activated if required, but that is not currently the case.
	My understanding is that the Yemeni Prime Minister is under house arrest. I have no further information on that at present. The right hon. Gentleman is right to underline the spoiling activities of AQAP, and that has already been underlined in the House. AQAP continues to undermine and harass the Government and to undertake targeted assassinations and mass bombings. This makes the situation ever more complex, with the Houthis moving in from the north-west.
	The right hon. Gentleman spoke about the constitution and the referendum. They are the building blocks that lead us to a better political space, and they are part of the national partnership for peace agreement, which I mentioned in my opening remarks.

Tim Farron: I am grateful to the right hon. Member for Leicester East (Keith Vaz) for bringing this important matter before the House and to the Minister for his thoughtful and informative replies. Does the Minister agree that in supporting the legitimacy of President Hadi, we must be wary of imposing a simplistic anti-terrorist narrative on the reported coup, given that it is likely that the coup’s origins are in more localised tribal, factional or sectarian sources?

Tobias Ellwood: I should make it clear that, historically, Yemen is a country that has never been broken down along sectarian lines and we hope that is not gong to be the case here. We remain firmly committed to supporting both the integrity of the Yemeni state and President Hadi’s elected Government to implement this peace agreement, along with all parties, including the Houthis.

Stephen Doughty: First, may I associate myself very much with the comments of my right hon. Friends the Members for Leicester East (Keith Vaz) and for Warley (Mr Spellar) and the right hon. Member for Rutland and Melton (Sir Alan Duncan)? The situation in Yemen is of great concern to many constituents of mine in Cardiff, particularly in Butetown and Cardiff bay, many of whom are of Yemeni heritage. What advice does the Minister have for those who may be worried about friends, family and relatives who are British citizens but who may not have followed the travel advice and may be in Yemen at the moment? Can he suggest what specifically they should do, and can he also give an assurance that the UK Government will give this issue a much higher priority, not only because of the current situation, but because of the poverty and insecurity that there have been in Yemen for far too many years?

Tobias Ellwood: The hon. Gentleman raises two very important points. First, while this subject may not have had a high profile in the media, that does not mean it has been a low priority for the Foreign Office, the United States and the Friends of Yemen—including in our work with Saudi Arabia. It is of huge concern, but it has not been on the front pages.
	Secondly, I agree that many of our constituents will be concerned about what is going on and for loved ones and friends. I advise the hon. Gentleman to encourage his constituents to look at the FCO website, where there will be updates and information on ways to get in touch
	with the Foreign Office desk. If there are any complications, I would ask him to get in touch with me personally and I will make sure that that communication link is established.

Peter Luff: Mr Speaker, there is a considerable irony in the fact that this debate on the crisis in Yemen comes immediately after your welcome statement on the British experience of the rule of law and democracy. What financial assistance are the Government providing to help stabilise Yemen?

Tobias Ellwood: My hon. Friend makes an important point about the British assistance being provided. We are working not only with the Friends of Yemen, but with the Deauville partnership of nations—a group that came together to support the countries that went through the Arab spring. We also have conflict pool money going into the country, and we are providing security assistance to the Yemeni armed forces. We provided over £173 million from 2011 to 2014, and then we committed a further £78 million for this year—2014-15. That funding comes from the development stabilisation programme.

Stephen McCabe: It has been alleged that the Houthi rebels are receiving support and backing from Iran. If that is true, will the Foreign Office consider whether it is in our interests to reopen an embassy and diplomatic relations with that country while it continues to meddle in such a malign way in this part of the world?

Tobias Ellwood: There is no doubt that Iran has influence in this area, and it can choose to be part of the solution or part of the problem. I very much hope it wants to be part of the solution and to play a helpful and productive role. It is no country’s interests to see Yemen descend into civil war.
	On the embassy, we can either shout from afar and complain about behaviour, or we can have a far closer relationship and put these things directly to the country and the Government. That is the objective of reopening the embassy, when the agreement is finally signed.

Bob Blackman: Further to that question on Iran, will the Minister update the House on what influence Iran can have over the Houthis to make sure they act in a positive way, so that we get a solution in Yemen that recognises democracy and the broad range of people who live within that state, and we ensure this coup comes to an end and people can live in peace?

Tobias Ellwood: My hon. Friend makes an important point. It is important that all neighbouring countries that have any influence over the various parties involved in Yemen should exert that influence to encourage the warring factions to come back to the table. I hope that Iran will heed that advice, so that we can move towards getting the partnership agreement back in place.

Mark Reckless: The right hon. Member for Leicester East (Keith Vaz) showed considerable personal courage in visiting Yemen, as do our ambassador and her diplomatic staff and the other UK nationals there. Will the Minister visit Yemen if the security situation allows?

Tobias Ellwood: It is certainly important to show support for our embassy personnel, and the more we can go to these places and engage with people, the better. Given the security situation, however, and the travel advice telling all Britons not to go there, it would be inappropriate for me to turn up there myself.

Jim Shannon: I thank the Minister for his statement, and the right hon. Member for Leicester East (Keith Vaz) for bringing this matter to the attention of the House. This affects us all in the United Kingdom, whether or not we have people from Yemen living in our constituencies. Will the Minister tell us what help the United Kingdom Government have given in the form of practical assistance, including additional intelligence surveillance equipment, extra technical and military aid for the army and, in particular, security scanning devices to prevent suicide bombings? Those three items would give practical help to reduce the level of warfare in Yemen.

Tobias Ellwood: The hon. Gentleman is right to suggest that the security situation in Yemen matters to people in Britain. From a strategic perspective, what happens in Yemen can have a consequential impact much further afield. We have a security relationship with the country, and if I may, I will write to the hon. Gentleman with more details of the areas in which we are working with the Yemeni armed forces.

BILL PRESENTED

Fracking (Measurement and regulation of Impacts) (Air, Water and Greenhouse Gas Emissions) Bill

Presentation and First Reading (Standing Order No. 57)
	Geraint Davies, supported by Kelvin Hopkins, Mr David Winnick, Jim Sheridan and Jim Shannon, presented a Bill to require the Secretary of State to measure and regulate the impact of unconventional gas extraction on air and water quality and on greenhouse gas emissions; and for connected purposes.
	Bill read the First time; to be read a Second time on Friday 27 February, and to be printed (Bill 158).

Onshore Wind Turbine Subsidies (Abolition) Bill

Motion for leave to bring in a Bill (Standing Order No. 23)

Nigel Adams: I beg to move,
	That leave be given to bring in a Bill to provide for the prohibition of the use of public funds to subsidise the development of onshore wind turbines; and for connected purposes.
	President Reagan once turned down $50,000 that Congress had authorised for redecorating the White House, but he did accept private donations to spruce up the presidential home on the sound basis that one man’s subsidy is another man’s tax burden. There is no better example of that than the burden of a levy on everyone’s energy bills to cover subsidy payments to renewable energy firms and landowners who happen to have wind farms or individual turbines on their land—the irony being that those who are already asset-rich become even more wealthy at the expense of hard-working taxpayers.
	It is fair to suggest that renewable energy should be subsidised to some degree to help stimulate a market, and I agree with that. I am not against all renewable energy subsidies, but we should be supporting technologies that are effective in producing power when we need it and not just when the wind blows. There are technologies that get a relatively poor deal from the subsidy market, and when we look at the efficiency data for onshore wind, we can see why wind is a bad deal for taxpayers. Onshore wind farms are dependent on the wind blowing at the right speed in order to reach maximum output. Because wind speed is variable, so too is the output of Britain’s onshore wind farms. As a result, onshore wind farms are unable to respond to spikes in demand, in contrast to other forms of low carbon generation such as the biomass conversion projects that are being so ably demonstrated at Drax power station in my constituency and that I hope will shortly be introduced at Eggborough power station.
	Onshore wind farms generate below 20% of their stated maximum output for 20 weeks a year, and below l0% for nine weeks a year. That means that wind farms are, effectively, failing to reach maximum output capacity for more than half the year. On average, they exceed 90% of their rated output for only 17 hours a year. That is about as much use as a chocolate fireguard. Worse still, Britain’s onshore wind farms are routinely paid large sums of money not to generate electricity—as much as £l million in each week of 2014. Those payments, described officially as constraint payments, ultimately end up on consumers’ bills, meaning that the British public are effectively subsidising the UK’s onshore wind industry not to produce electricity.
	Research by the Renewable Energy Foundation shows that Whitelee in Scotland, the site of Britain’s largest onshore wind farm, was paid more than £22 million in constraint payments last year. In other words, it was paid £22 million of taxpayers’ cash not to produce anything. Very nice work indeed if you can get it! Last year, a total of £53 million was paid in constraint payments to wind farms—both onshore and offshore—which is the most since 2010. Wind farms are being paid more than £1 million a week to switch off their turbines.
	I am sure that the wind industry will tell us that this method of electricity generation is a way to create jobs. The industry's trade body, RenewableUK, states that the industry
	“is set to employ up to a further 70,000 people by 2023”.
	The promise of those jobs is totally dependent on the building of large-scale wind farms at sea and the construction of factories in Britain to manufacture the turbines, which are almost all built abroad at the moment. The Scottish energy Minister published figures last year showing that 2,235 jobs were connected directly to onshore wind at 203 wind farms across Scotland, so with an annual subsidy of £344 million, that works out at a cost of £154,000 per job.
	The renewables obligation was introduced by the Labour Government to encourage investment in and development of the renewable energy industry. The cost is added to all energy bills, meaning that not only households but industry and employers pay, adding to the cost of all our goods and services. Labour also signed us up to meeting legally binding green energy targets by 2020, with the prospect of financial penalties if we failed to do so. Surely the only possible justification for subsidising these technologies is to drive down costs, but Labour ignored that principle and decided to use subsidies to meet arbitrary and foolishly high targets for green electricity in a very short time scale.
	I should like to mention single turbines. These are usually applied for and sited on farmland and they operate under a different regime, the feed-in tariff. Farmers are paid to generate even if they use the power themselves, and they are paid a further amount on top of that for any power fed into the grid. For example, the basic tariff on a 50 kW turbine is 17.78p per kWh, which is £177.80 per MWh, and a further £47.70 for power fed into the grid. If a farmer with such a turbine uses 80% of the power himself, which is not unrealistic, the power fed into the grid and therefore paid for by the consumer will cost a staggering £936.70 per MWh, which is nearly 20 times the wholesale market price. In the case of the owner of a 500 kW farm turbine who uses half the power generated, the price paid by the consumer for the power fed into the grid would be £344.10 per MWh, which is more than six times the wholesale market price. That does not make sense. Those examples show the extent to which the electricity market and, potentially, the farming market are being distorted by this subsidy. A farmer who can get an income of more than £200,000 a year from a turbine has a lesser incentive to improve the competitiveness of his farming activities.
	A report produced by Frontier Economics on behalf of the Department of Energy and Climate Change concluded that Britain’s wind energy subsidy was 35% more expensive than the international average. Two countries in particular, Germany and Denmark, have been at the forefront of promoting wind energy. Germany pays £80 per MWh for its electricity from onshore wind, while in Denmark the cost is less than £60 per MWh.
	In the last few weeks, we have discovered—thanks to private conversations between the industry and the Labour party—that if, God forbid, Labour was to return to power, it would want to see even more turbines erected across the country. At least neither our comrades
	the Liberal Democrats nor the Green party—[Hon. Members: “Where are they?] They are not here; they are conspicuous by their absence. At least they have never tried to hide their love of these carbuncles in our countryside. Voters now know that the Labour party, alongside the Lib Dems and the Greens, has no issue with voters paying more for their energy bills and that it cares little about the impact that large turbines have on rural communities.
	If wind power really is the cheapest form of renewable energy, as its supporters claim, it should now be able to stand on its own feet without using any more taxpayers’ money and increasing our bills. I am delighted that my right hon. Friend the Prime Minister has said that if the Conservatives achieve an outright majority after the election, subsidies for onshore wind will end. That is welcome news to my constituents in Thorpe Willoughby, Hambleton, Gateforth, Hillam, Riccall, Kirkby Overblow and Spofforth, and right across the beautiful part of North Yorkshire that I represent. I know it is also welcomed by constituents of many of my right hon. and hon. Friends.
	I do not blame farmers and landowners for wanting to join in this gold rush. They do not set policy; the Government do, and it is time to call time. We have more than 8,000 onshore wind turbines operational in this country, with 1,300 under construction, 5,200 awaiting construction and almost 6,000 in planning. I agree with Thomas Pursglove, our candidate in Corby and the chairman of Together Against Wind, when he says that enough is enough. My Bill is designed to help communities that feel threatened and powerless in the face of wind farm applications, and to ensure that our constituents are getting good value for the money they pay on their bills. The Bill will also allow other, more efficient technologies to benefit from Government support, and I commend it to the House.
	Question put (Standing Order No.23).

Mr Speaker: I am sure the hon. Member for Wellingborough (Mr Bone) will be well familiar with the principle that vote should follow voice. It is a fundamental tenet of our parliamentary proceedings, of which the hon. Gentleman, a noted constitutionalist, will be very conscious.

Peter Bone: indicated assent.
	The House divided:

Ayes 59, Noes 57.

Question accordingly agreed to.
	Ordered,
	That Nigel Adams, Chris Heaton-Harris, Sir Paul Beresford, Mr Philip Hollobone, Philip Davies, Jackie Doyle-Price, Mark Garnier, Andrew Bridgen, Mike Weatherley, Mr Ian Liddell-Grainger and Sir Greg Knight present the Bill.
	Nigel Adams accordingly presented the Bill.
	Bill read the First time; to be read a Second time on Friday 6 March, and to be printed (Bill 159).

Opposition Day
	 — 
	[14th Allotted Day]

National Health Service

Andy Burnham: I beg to move,
	That this House notes comments from leading experts that the NHS is under unprecedented levels of pressure and that this is putting patient care at risk; further notes that attendances at hospital A&E departments increased by 60,000 in the last four years of the previous Government and 600,000 in the first four years of the current Government; believes that this is linked to decisions taken by this Government, including cuts to adult social care, the abolition of NHS Direct, the closure of almost one in four walk-in centres and removing the GP access guarantee; and calls on the Government to match the Labour Party’s plans to raise an extra £2.5 billion a year for the NHS, funded by measures including a tax on properties worth over £2 million, to help ease the current pressure and ensure that the NHS is fit for the future.
	We have called this debate today to see if we can establish a shared analysis across the House of the causes of the current crisis in accident and emergency departments, and from that, shared solutions. I hope we can all agree that the staff of the national health service and of the ambulance service are working wonders in the most trying circumstances, and that it behoves all of us to put forward our ideas today to relieve the pressure on them, but more importantly, to reduce the risks that too many patients are facing right now.
	As I have said to the Secretary of State before, things cannot carry on as they are. As the British Medical Association said last week,
	“these ongoing challenges are placing patient care and safety at risk.”
	Very poorly people are waiting hours for ambulances to arrive, hours to be seen in A and E, and hours on trolleys in corridors, and too many elderly people are then being held on hospital wards, trapped for days, weeks, even months or, in one case that I will come to later, a full calendar year.

Hywel Williams: Can the right hon. Gentleman establish for the benefit of the House whether the figure quoted in his motion applies to England and Wales or to England only?

Andy Burnham: I am not sure which figure the hon. Gentleman is referring to, but the figures in the motion apply to England. I will say more about them in a moment.
	The stories of failure keep coming. Today we read that a 38-year-old man in Bristol died of meningitis after an ambulance took four hours to arrive. This is by no means an isolated example. The response time target for the most serious calls has been missed for the past six months in a row. We need to hear today what the Secretary of State is doing about this. Rather than work to improve response times, the only proposal we have heard so far is to allow a pilot relaxing response time standards. There will be two pilots, one in the south-west and one in London. London, as the right hon. Gentleman knows, is the worst-performing ambulance service in the country right now, and we hear today that the chief executive of London ambulance service, Ann Radmore,
	has resigned. The Secretary of State will need to explain to us today why it makes sense, in the middle of a difficult winter, to run an experiment in the most troubled ambulance service in the country.

Several hon. Members: rose—

Andy Burnham: I give way to the right hon. Member for Wokingham (Mr Redwood).

John Redwood: I am grateful to the shadow Secretary of State. Can he explain why Labour only ever now has any interest in England’s health service? We would like to hear about Labour’s conduct of the Welsh health service and its message for Scotland. Does Labour not know that this is an English devolved matter?

Andy Burnham: It is my responsibility to hold the Government to account on behalf of patients in England for what is happening in England now. That is my job, and I will make no apologies to the right hon. Gentleman or anybody else for doing it.
	The response times in the ambulance service are not good enough, nor is the plan to introduce an experiment in the middle of winter, but the problems are not confined to the ambulance service. We need, too, to relieve the pressure on hospitals. Last week just seven out of 140 hospital A and E departments in England met the Secretary of State’s lowered A and E target. Hospital staff are trying their best, but it is as if the Government have simply given up on it. If that is so, that means that they are giving up on the thousands of people waiting hours to be seen. What is his plan to stop the decline and bring A and E back up to acceptable standards? It is time he told us.

Several hon. Members: rose—

Andy Burnham: I give way to the Chair of the Health Committee.

Sarah Wollaston: I thank the right hon. Gentleman for giving way. I am concerned. Does he understand the difference between a pilot and an experiment? Does he not think it is right that the Secretary of State should listen to clinically led advice about how we might improve ambulance waiting times, rather than just roll out changes without a pilot, not an experiment?

Andy Burnham: I do not think there is a massive difference between a pilot and an experiment. My objection is that that is being introduced in winter—and a difficult winter at that—in the most troubled ambulance service. I am not against a pilot, but it should be conducted at a quieter time of year. I should have thought that bringing it in now would strike the hon. Lady, with her long experience of the NHS, as more than a slightly risky thing to do.
	I need to hear today the Secretary of State’s plan. What is his plan to bring standards in ambulance services and A and E back up to where they should be? If he waits much longer to tell us, people will conclude that
	he simply does not have one. The simple truth is that our hospitals are full and operating way beyond safe bed occupancy levels. It is a system that is visibly creaking at the seams.

Several hon. Members: rose—

Andy Burnham: I shall give way in a moment.
	Another recent case symbolises just how bad things have got. Michael Steel, a dad of two, aged 63, was moved from his ward to a store cupboard while being treated for an inflamed liver. Mr Steel was unable to sleep because he was wheeled in and out of the cupboard while staff went to get drugs from the fridge. One nurse apparently told him it was “absolute chaos”. His son Tom took pictures of the ordeal, including a photo of the ward’s whiteboard where nurses listed his dad’s location as “stock room”. This is the NHS on the Secretary of State’s watch.

David Anderson: I agree with the Chair of the Health Committee that the Secretary of State and his Ministers should listen to the professionals on the front line. If they had listened three years ago, we would not have been lumbered with the Health and Social Care Act 2012, because everyone at the professional end of the health service said, “Do not do it.” But they were ignored by the Secretary of State.

Andy Burnham: What we can see is that this decline began when the Government made the monumental misjudgment of bringing forward a top-down reorganisation that should never have happened, that nobody voted for, and that took 1.5 million eyes off the ball in the NHS. The Government should have been looking at the front line and maintaining standards there, instead of which they looked backwards, and focused on the reorganisation and the jobs merry-go-round that then carried on. It is really disgraceful that they did that and plunged the NHS into the chaos that it is today.

Derek Twigg: Last Friday evening, I spent time at Whiston A and E talking to doctors and nurses, who do an unbelievable job. I heard about the problem of getting elderly people back into the community when they have undergone treatment. There were also issues around recruiting and retaining nurses and the tariff there, but there does not seem to be any answer coming from the Government.

Andy Burnham: My hon. Friend describes the problems well. I know the hospital because I have been there with him. He is right that older people are becoming trapped in hospital. The support is not there for them in their own homes, and nursing home places are not available. I will come back to that theme in a moment.

Barbara Keeley: On exactly that point, the Health Committee looked at the A and E crisis last week and was told by the president of the College of Emergency Medicine that delayed discharges were due to under-investment in the community, by which he meant social care, GPs and district nurses. Indeed, one third of delayed discharges
	were down to social care. One third of frail elderly people, or vulnerable people, cannot go home because of the issues with social care, which has been cut by £3.53 billion under this Government.

Andy Burnham: We have record numbers of delayed discharges in the NHS right now. The number may even go past the 1 million mark—I am talking about days lost in the past year. That reorganisation that I mentioned a moment ago cost at least £3 billion, probably more. The budget was flat so where did that money come from? As my hon. Friend rightly says, it came from cuts to the general practice budget, cuts to the community services budget, cuts to the mental health budget and cuts to the social care budget. That is why the community has been stripped bare and people are trapped in hospital. This is a mess of the Government’s making.

Angela Smith: Does my right hon. Friend not agree that as far as ambulance response times are concerned, the same explanations apply, by which I mean the closure of the NHS Direct service, the cuts to the social care and the difficulties in seeing a GP?

Andy Burnham: That is exactly my argument.

Several hon. Members: rose—

Andy Burnham: I will make some progress.
	I mentioned record numbers of delayed discharges. There are also record numbers of people visiting A and E, record numbers of frail people being admitted through A and E, record numbers of people waiting on trolleys and record numbers of people trapped in acute hospital beds. This is the simple question that has not yet been answered by this Government: why is there this unprecedented pressure in accident and emergency? Until there are proper answers to that simple question—and agreement about the true causes of the A and E crisis—we will not be able to move forward with a proper solution, and that is the point of today’s debate.
	When the Secretary of State came here to answer the urgent question two weeks ago, he was asked by my hon. Friend the Member for Halton (Derek Twigg) what he saw as the causes of the increased attendances at A and E. Let me remind the House of what he said:
	“We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population...The second factor is changing consumer expectation among younger people who want faster health care…The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.—[Official Report, 7 January 2015; Vol. 590, c. 280.]
	In other words, “Nothing to do with us, Guv.” It is the same old story with this Secretary of State. It is always someone else’s fault: older people’s fault, younger people’s fault, the previous Government’s fault—anyone but him.

Helen Jones: My right hon. Friend knows Warrington well. As well as increasing ambulance response time and having fewer GPs than we had in 2010, we are now seeing one of the last specialisms—spinal services—moved from Warrington to Walton with no public consultation whatever. Does
	he agree that this is exactly the result of the Government’s reorganisation in which no one is accountable for any decisions and the future of hospitals such as Warrington is at risk?

Andy Burnham: My hon. Friend is right; I do know Warrington well. Speaking up for my own family who live in Warrington, I will not accept a situation in which their services are taken away without them having the democratic right to challenge those decisions. But that is what has been growing under this Secretary of State. We had the decision on Lewisham—the most outrageous example—in which he tried to close a successful A and E that was serving a very deprived part of London, without any proper process, and he lost in the High Court. Then we had a clause brought before the House that tried to close hospitals anyway. That is what the Government want to do; they want to ride roughshod over local people and close services where they want to, and we will not let it happen.

Several hon. Members: rose—

Andy Burnham: I will give way to my hon. Friend before making more progress.

Karen Buck: If the causes of the A and E crisis are deep and structural, as the Secretary of State has implied, why is it that the number of people in London waiting outside A and E in ambulances rose by 66% in one month—between November and December?

Andy Burnham: As usual, my hon. Friend puts her finger on the issue: the crisis is not as the Secretary of State describes. I will come on to that right now, but the first request I will make of him today is to publish the research that proves that the three top reasons he gave in this House two weeks ago are indeed the reasons for the increased demand in A and E, because I do not believe that they are. Perhaps they have made a small contribution, but they are not the real reason for the crisis. Our analysis of what is behind the extra pressure is very different from his. Let me introduce an important and revealing fact into this debate, which picks up on my hon. Friend’s point.
	Over the past four years of the previous Government, annual attendances at A and E increased by 60,000. Over the first four years of this Government, they have increased by 600,000. That is a dramatic increase, which is explained not by those long-term structural issues, but by decisions taken by this Government.

Henry Smith: Under the previous Government, Crawley’s accident and emergency was closed. Will the right hon. Gentleman now commit to increasing funding on the NHS, as this Government have done every single year of this Parliament, and promise to do for the next?

Andy Burnham: Changes we made were done in a planned way, with measures to increase capacity at neighbouring accident and emergency departments, and they were done for reasons of patient safety. Have a look at west London, where plans to close A and E
	departments are being railroaded through, leaving intolerable pressure on the remaining A and E departments. It is not acceptable, and the hon. Gentleman should challenge his own Government on what they are doing.

Caroline Lucas: Does the right hon. Gentleman agree that with private health firms now on course to win more than £9 billion of NHS contracts, one of the real problems is the fragmentation of the NHS in front of our eyes. Is that a good reason to oppose further privatisation of the NHS, and will he admit that the process that set in train the privatisation of Hinchingbrooke should never have happened?

Andy Burnham: I have said that the market was let in too far, and, as Health Secretary in 2009, I changed policy away from what was a version of “any willing” or “any qualified” provider to “NHS preferred provider” and I stand by that. I agree with the hon. Lady that the market is simply not the answer to 21st-century health and care. When the Prime Minister stood at the Dispatch Box about an hour or so ago and said no privatisation on his watch, he was not being straight with the public. Services across the country are being put out to open tender and then transferred to the private sector. That is the Government’s record and the people of this country know it.

Paul Blomfield: Does my right hon. Friend agree that it says everything about this Government’s attitude to the NHS that general practices that serve the most needy and vulnerable patients, like Devonshire Green and Hanover medical centres in my constituency, are under threat because of the withdrawal of the minimum practice income guarantee introduced by Labour? Does he agree that the Government should immediately stop the phased withdrawal of funding and review their decision to end MPIG?

Andy Burnham: I said earlier that there had been cuts to the GP budget, and that is one of the implications of those cuts. The Government have developed a plan to phase out the guarantee that secures practices in some of the more deprived communities. In east London there have been campaigns against practice closures; I know there are similar concerns in Sheffield. That process should be reviewed and if necessary stopped, because no practice should close as a result of any of those changes. That is the commitment I give to my hon. Friend today.

Several hon. Members: rose—

Andy Burnham: I want to make some more progress; I will give way later.
	We need to know the reasons for the increase in A and E attendance. Safely meeting that demand would require an extra eight accident and emergency departments in England, but the Government have been closing, not opening, A and E’s. That is why there is so much pressure in the system.
	There has been an even more dramatic increase in the last year. NHS England figures show that there were an extra 446 extra visits to A and E in the 2014 calendar year.
	That is a dramatic change on the Secretary of State’s watch and the time has come for some honesty from him about the real reasons for it. Until he faces up to those reasons, however uncomfortable they may be for him, he will not be able to develop a proper solution and the situation will get worse. We cannot let that happen.
	Let me list what I believe are the decisions of this Government that led to the increase. I will identify four and take each in turn. The first, as Opposition colleagues mentioned, is the decision to scrap NHS Direct and replace it with the flawed NHS 111 service. NHS 111 was originally intended to be a call-handling service, and indeed was conceived by the previous Government. It was intended to simplify access; it was intended to patch people through to the relevant agency, be it the GP out-of-hours service or NHS Direct.
	However, when the present Government came into office, they made a major change: they decided that NHS 111 would not signpost NHS Direct but replace it. That was a major mistake. The established and trusted NHS Direct model, a single national contract in the public sector, was replaced with 46 patchwork contracts in the public and private sectors across the country. They replaced the model of nurses on the end of the phone, to provide reassurance for families, with call handlers and computer screens. As a result, where 60% of calls to NHS Direct were handled by nurses, with NHS 111 it is only 20%.
	But the present system of call handlers and computer screens is not a case of “computer says no”. The problem is that too often it is a case of “computer says, ‘Go to A and E.’” NHS England figures show that there has been a dramatic increase, in the last year, in the number of people calling NHS 111 who are referred to A and E, or to whom an ambulance was dispatched. In November 2014, there were 67,000 referrals to A and E—a 26% increase on the same month in 2013—and 108,000 ambulances dispatched—a 20% increase on November 2013.

Alex Cunningham: All these problems have led to an increase in the number of days that people are taking off as a result of stress—nurses especially. Thousands of days are being lost to the system, adding to the crisis. Should we not be appreciating the staff in our NHS hospitals, and maybe starting by awarding them the 1% pay rise that the pay review body recommended for all of them?

Andy Burnham: The Secretary of State’s decision to reject the independent advice of the pay review body about what was fair and affordable, and to single out NHS staff for exclusion from the promise that the Chancellor had made that the public sector, as part of his restraint policy, would get 1%—to say that NHS staff would get less than that—was a kick in the teeth, and was to risk staff morale just at the moment that the NHS needed to be recognising and rewarding those staff, who are working so hard to keep things going. To make inflammatory comments such as those that the Secretary of State has made in the newspapers today is the wrong response. He should be getting back round the negotiating table with those staff. He should be working with them to find solutions. They are keeping the NHS going right now, and they deserve a bit better than they have had off this Secretary of State.

Alison McGovern: May I return my right hon. Friend to something very important that he said? He pointed to the distress of our constituents who are being told to go to A and E rather than having reassurance from a nurse on the end of the phone. This is the experience of all our constituents right now, and I would far rather all my constituents had access to a qualified nurse than were just told to go to A and E.

Andy Burnham: My hon. Friend calls it just right. One thing the Government could do right now would be to get more nurses on the end of those phones, to provide that experienced voice, that reassurance, that people with young children need before they decide to get in the car and go to A and E. I remember using NHS Direct in such circumstances myself. That reassuring voice has gone, and that is why NHS 111 is placing additional pressure on our A and E. The Secretary of State would not recognise it, with the reasons that he gave, but it is. Staff know it is. The ambulance service know it is. It is time we had a Government who faced up to that reality. My question for the Secretary of State today is: will he now concede that that flawed 111 service has contributed to the 600,000 annual increase in A and E attendances?
	The second policy decision that I shall discuss is the closure of NHS walk-in centres. Colleagues who have been in the House for some time will recall that there was a winter crisis in A and E in most, if not all, winters in the 1990s. Then, in the late ’90s, NHS Direct was launched and NHS walk-in centres were opened, with the specific intention of giving people alternatives to attending A and E, which were then under major pressure. The locations of the first wave of walk-in centres were carefully chosen, often where an A and E had recently closed, including at Leigh infirmary in my constituency. In the decade from 2000 to 2010, around 230 walk-in centres were opened across England. Many of those centres became an established and understood alternative to A and E.
	However, despite strong evidence to support them, a review by Monitor has found that almost one in four walk-in centres have closed under the coalition Government. Many more are under threat today. Monitor’s review surveyed people who used walk-in centres, and one in five said they would have gone to A and E if that alternative had not been available. Here is my next question for the Secretary of State: will he now concede that, in the areas where those centres have closed, there will have been extra attendances at A and E, and that was it a mistake to close those centres?
	Thirdly, I will mention GP services, but let me start by clearing something up. The Prime Minister claimed today at Prime Minister’s questions that there are more GPs now than when he took office. I am afraid, as so often is the case at Prime Minister’s questions, that claim is simply not true. The last census of the GP work force conducted under the previous Government, in September 2009, found that there were 35,917 GPs working in England. The latest census for which figures are available, September 2013, finds 35,561 GPs working in England. When will Ministers start giving out facts from that Dispatch Box, rather than the spin we get week after week?

Tom Blenkinsop: I asked the Prime Minister some weeks ago about the number of nurses in the NHS. In December, the number of NHS nurses in the system had been reduced by over 900 since May 2010, but we were told in November that it was up by about 2,500. The Government were using the figures, and the Prime Minister was answering questions, in terms of hours worked. As we know, nurses are working massive amounts of overtime on single-rate time. Nominal headcount nurses, at this moment in time, are minus over 900 compared with May 2010.

Andy Burnham: My hon. Friend makes his point very well. This is what we must challenge as we move forward. Before the general election, people need the facts about what is happening to the NHS. There has been a big drop in the number of nurses working in the community, as my hon. Friend mentioned, and these are the facts that we need to bring home to people.
	It is not just the fact that the GP headcount has gone down. One of the present Government’s first acts was to scrap the guarantee of an appointment within 48 hours and incentives to open GP surgeries in the evenings and at weekends. That, combined with cuts to the GP budget, means that it has got harder and harder to get a GP appointment in recent years. The constituents of all the Members present say, “I am ringing the surgery at 8 or 9 every morning and being told that nothing is available for days.” In 2010, the vast majority—80%–of people said they could get an appointment within 48 hours; now, according to the GP survey, one in four people say they must wait a week or more to see a GP.

Bill Esterson: One of the problems in my constituency is that GP surgeries are relying on locums because it is not possible to find GPs to recruit on a full-time basis. Those locums provide a very erratic service; sometimes there is not even a locum available. That is adding to the problem, because as a result, all that is left to people is to go to A and E. I am sure that my right hon. Friend agrees that that is one of the contributory factors, and it proves his point that a chronic shortage of GPs has come about under this Government.

Andy Burnham: That is an absolutely vital point. It is not just about GP locums; there are also A and E locums. The Government have, throughout, cut training places, which were another victim of the reorganisation. Ever since then, the number of places commissioned for doctors—and nurses, I might say—has gone down. That leaves us with a bill for agency staff that is literally out of control—it has gone through the roof—and that means that money is now being siphoned out of the NHS at an alarming rate. That is mismanagement; that is what has happened. How must staff working in the NHS feel when they see the bill for agency staff spiralling in this way and know that they will not even get a 1% increase from this Government? They will draw their own conclusions about how this Government value them.

Richard Fuller: The shadow Secretary of State has spent quite a large part of his speech on diagnosis, but at the beginning he asked for solutions, so in that spirit I offer a creative solution. He will be
	aware that East of England ambulance service has had very poor response times for a number of months—in fact, a couple of years. Would he support a merger of the Red 1 and Red 2 ambulance response services with the fire and rescue service in the east of England, because such a combined force might be in a better position to provide quicker response times? Does he agree with that idea?

Andy Burnham: I am prepared to look at it, but I think that the future of the ambulance service should be in integrating better with the rest of the NHS—with GP out-of-hours services and NHS 111. Greater Manchester’s health service is piloting a critical response service to support the ambulance service, and I do not have any objection to that. However, this Government have not got it right when they say that the future of the ambulance service is to merge with the police and fire services as a single 999 service. For me, the ambulance service is a clinical service that should integrate better with the rest of the NHS, and I would prefer to go in that direction.
	I said a moment ago that people could not get a GP appointment, and that is also what the GP survey tells us. An extra 290,000 patients say that they have turned to A and E when they cannot get a timely GP appointment. That includes the Secretary of State, who admitted in this House that he had done exactly the same. So will he today accept that the growing problem of people being unable to get GP appointments has played a significant part in contributing to the increase of 600,000 in the number of visits to A and E?
	Fourthly, I turn to social care. In my analysis, this is the root cause of the problems we are now seeing. At the start of this Parliament, I warned the Government about their public spending plans and, in particular, warned them against raiding social care to stack up a claim that they were protecting the NHS budget. Government Members should be familiar with the quote because the PM quotes it every week at Prime Minister’s questions. To be more accurate, they will be familiar with half the quote, because that is all he uses, so let me give the House the full version. I said that it would be irresponsible for the Government to increase NHS spending if the way they did it was by raiding the social care budget. I said further that if that goes ahead, they will hollow out social care to such a degree that the NHS will not be able to function, because a collapse in social care support would end up dragging down the rest of the NHS with it.
	That is precisely what is unfolding before our eyes right now in the NHS. A report today from Age UK shows how
	“hundreds of thousands of older people who need social care are being left high and dry.”

Marcus Jones: If we were unfortunate enough for Labour to win the forthcoming general election, by how much would it increase councils’ adult social care budgets?

Andy Burnham: I am talking about creating a single budget. There is a big difference between that and what the hon. Gentleman says. I am saying that the time has come to merge the adult social care budget and the
	NHS budget. More than that, we are going to put an extra £2.5 billion into that integrated system. He should not come here today telling me what I need to do: where is his plan to put more money into the national health service?

John Healey: My right hon. Friend is giving the House a very good analysis of the social care system. He may have looked at the National Audit Office analysis published in March 2014, which said:
	“The intention in the 2010 spending review was to protect spending on adult social care”.
	Despite that, because Ministers cut central Government funding for local authorities by 26%, councils have cut nearly £1 in every £10 spent on adult social care in the past four years, leaving Age UK’s director to describe the system as being in calamitous decline. That is clearly a central cause of the current A and E crisis, exactly as my right hon. Friend is arguing.

Andy Burnham: My right hon. Friend has absolutely nailed it. Those Ministers on the Front Bench decided—it was a political decision—to cut councils to the bone, and in doing so cut social care to the bone. That was precisely the warning that I gave back in 2010, having just left the Department of Health, where I remember being told that allowing social care to be cut would be a false economy of massive proportions because it would lead to huge inefficiency in the NHS. Hospitals would be unable to function because they could not get people home, and therefore the NHS would back up and the pressure would become impossible. That is what is happening. Those Ministers have done it, and they must be held to account for it.

Several hon. Members: rose—

Andy Burnham: I will give way one more time.

Andrew George: At the start of his speech, the right hon. Gentleman said he was calling for common ground and consensus in this debate, although he seems to have become somewhat deflected from that path. He knows that I very much agree with his criticisms of the Health and Social Care Act 2012 and other things. He has said, on a constructive basis, that he wants to bring health and social care together. There is potential consensus and common ground in that regard. I would like to hear what more he can say constructively on the areas where, I think, we can find, across all parties, common ground and a way forward.

Andy Burnham: To find common ground, one has to tell it straight and put on the table the real reasons why there is pressure in A and E. I bet the hon. Gentleman would not disagree with a single reason I have given: NHS 111, closure of walk-in centres, difficulty in getting GP appointments, the collapse of social care—[Interruption.] Yes, he says he does not disagree with any of those things. If we have a shared analysis, then he and I will have a basis on which to devise solutions. I will come to those solutions later.

Several hon. Members: rose—

Andy Burnham: I said that I am going to make progress.
	Today’s Age UK survey finds that the number of over-65s receiving care has fallen by 380,000 under this Government. Half of the 1 million people who struggle to wash or bathe now get no help at all. Two thirds of the 250,000 people who struggle to feed themselves every day are now left to fend for themselves. There are over 100,000 fewer day care places and over 50,000 fewer people getting meals on wheels. Age UK says:
	“Our state-funded social care system is in calamitous, quite rapid decline.”
	But worse, it is dragging down the NHS.

Sarah Newton: Will the right hon. Gentleman give way on that point?

Andy Burnham: In a moment. I said that I had given way for the last time, but I will do so once more for the hon. Lady.
	Record numbers of very frail, elderly people are arriving at A and E due to a lack of support in their own homes. Between 2009-10 and 2012-13, there was a 48.1% increase in the number of people aged over 90 being admitted to A and E via blue-light ambulance—in other words, 100,000 very frail, very frightened people in the backs of ambulances going round our towns and cities to be dropped off at a busy A and E. That is what is happening on this Government’s watch.

Sarah Newton: Today’s Age UK report contains aggregated England data. Does the right hon. Gentleman not agree that all over our country there are councils integrating social care with the NHS, and, indeed, increasing their social care budgets? Does he not recognise the good work that is going on in the integration pilots in Cornwall, for example?

Andy Burnham: I have repeatedly praised Torbay council in the hon. Lady’s part of the world, which was the well regarded pioneer of integrated care. Yes, there are examples of councils around the country trying to do the right thing, but let me make two points: first, the Torbay model has been broken apart by the Health and Social Care Act; and, secondly, councils are trying, but they have been battered by the massive cuts to their budgets about which Age UK is warning today, and which are setting back the cause of integration.
	The reality is that elderly people are going into A and E and getting trapped there. As I have already mentioned, there is the sad case of an elderly women in Lincoln who spent an entire calendar year in hospital because a care home place could not be found. That is simply wrong on every level, and it is unsustainable in human and financial terms. The collapse of social care is a root cause of the current A and E crisis because it has led to increased pressure at the entrance door of the hospital, and to the exit door becoming blocked.
	For those who still get some support, 15-minute visits are becoming the norm. Richard Hawkes, chairman of the Care and Support Alliance, has said that A and E
	“is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”
	My last question to the Secretary of State is: does he agree with Richard Hawkes that cuts to social care have contributed to the extra 600,000 people who now attend A and E every year?
	The evidence is clear: on NHS 111, on walk-in centres, on GP services, on social care—this is a mess of the Government’s making. I am sure that the text of the Secretary of State’s speech is full of the usual spin and self-serving excuses, but he must not sit down until he answers directly the four questions I have put to him, not for my benefit, but so that he does not insult the intelligence of the people watching. He is in charge, not me. People are looking to him for answers and solutions, so let me give him some in the time I have left.
	As I have said, let us get nurses back on the end of the phones at NHS 111, and let us have a review of the 111 service. I hear that contracts are about to be signed—for instance, to take a contract off an ambulance service—and they will extend this flawed model of care. Will the Secretary of State intervene to stop those contracts being signed until there has been a proper review?
	Will the Secretary of State review the plan to relax ambulance response times in the pilot? That is surely the wrong response during this very difficult winter. Is he absolutely convinced that now is the right time to experiment with relaxing established standards? Does it not make sense to delay it until a quieter time of the year, and not to do it in the most troubled ambulance service in the country?
	On walk-in centres, would not one of the simplest things the Secretary of State could do to stop the A and E situation getting worse be to commit to halt any further closures? We know that walk-in centres in Jarrow, Nuneaton and Chelmsford are under threat. Would it not help everybody if he just removed that threat today? On GP services, has he considered putting a GP in every A and E?

Marcus Jones: Will the right hon. Gentleman give way?

Andy Burnham: I have said that I will not give way again.
	All those measures could help in the short term, but the truth is that all parties must recognise that there will not be a long-term solution to the A and E crisis until we face up to the crisis in social care, and rethink how we care for the most vulnerable older people. It is not just about money; we need radical changes in the way we use existing budgets for health and care. We need to merge them so that we can change the way in which we care for older people. We need a model of care that starts in the home and supports people there, so that we can drastically reduce the numbers unnecessarily ending up in hospital and becoming trapped there.
	Although that model is not just about money, it is partly about money: if such a transformation is to happen, extra investment will be needed to stimulate it. The Secretary of State likes to hold up the better care fund, but I am afraid that councils and the NHS simply do not share his optimism. It robs Peter to pay Paul: the money transferred to councils is nowhere near enough to backfill the cuts to social care, and it leaves a deepening hole in NHS finances. [Interruption.]
	The Secretary of State asks where I would get the money from, and I will tell him. The Opposition have committed to provide extra money for an integrated NHS—£2.5 billion a year over and above what he has committed—with social care as part of a single service for the whole person. By contrast, under the public spending plans the Government have set out for the next Parliament, it is clear not only that the A and E crisis will deepen every year, but that it will soon become a full-blown NHS crisis.
	The NHS used to be the Prime Minister’s priority; now it does not feature in his top six election themes. We know that there will be no money for it beyond what the Government have promised, because the priority is tax cuts for higher rate taxpayers, although they have not yet identified where the money for that will come from. If the outlook for the NHS is grim, it is utterly dire for local government and social care. Taking public spending back to 1930s levels will absolutely decimate what is left of our social care system, and if the system goes into freefall today’s problems in the NHS will become entrenched. Will the Secretary of State go back to the Chancellor, argue for a better deal for the NHS and social care, and match Labour’s pledge to prevent a permanent care crisis in the next Parliament?
	The NHS is now at the crossroads, and the coming election presents an enormous choice between Labour’s plan to lift the NHS out of its current crisis by investing £2.5 billion in the NHS of the future, and the coalition approach under which—with the Government unable to face up to the mess of their own making in A and E or to produce a plan to turn it around, and unwilling to find the extra money it needs—the NHS is dragged down by a toxic mix of cuts and privatisation. The stakes could not be higher. This crisis cannot go on: patients have suffered enough. They need an election, a change of direction and a Labour Government to secure the NHS.

Jeremy Hunt: What utter, disgraceful nonsense! I will rebut every single thing that the right hon. Gentleman has said.
	This has been a tough winter for the NHS, and I first want to pay tribute to the hard work of staff on the front line who have been working exceptionally long hours in very challenging circumstances. What they want right now is practical help, a vision for the future and a sensible plan to get there—all of which this Government are delivering. They do not want to be turned into a political football. The public have noted that while Labour Front Benchers sometimes sound restrained in parliamentary debates, they are the opposite in the TV studios, where they do everything possible to whip up panic and a sense of crisis. That is not the behaviour of a responsible Opposition.
	As NHS England and the King’s Fund have said, the NHS is coping well under real pressure and, in the words of Dr Cliff Mann, president of the College of Emergency Medicine, trying to weaponise it for political purposes is “toxic”. Indeed, Professor Chris Ham, of the King’s Fund, said this week:
	“This is a long-term issue not to do with this particular government—the previous government faced many of the same challenges...patients who are really poorly will still get a very good and very quick service.”

Angie Bray: In contrast to what we have heard from the Opposition, will my right hon. Friend join me in welcoming the seven-day-a-week GP surgeries opening up across Ealing and Acton and the plans for the new walk-in health centre for Acton? Will he join me in condemning the Labour-led council’s decision last night to cut the public health budget?

Jeremy Hunt: That is the reality: there are new and improved services for the NHS up and down the country, but what we get from the Labour party in my hon. Friend’s constituency is scaremongering leaflets saying that hospitals are being closed when they are not. Labour should apologise for scaring very vulnerable people. It claims to stand up for them, but by scaring them it is doing the exact opposite.

Marcus Jones: Unfortunately, the right hon. Member for Leigh (Andy Burnham) did not do me the courtesy of giving me a right of reply when he mentioned the walk-in centre in my constituency. Does the Secretary of State not think that it was completely irresponsible for the right hon. Gentleman to make such comments, given that the issue was raised by a whistleblower and that the information does not come from the clinical commissioning group that is considering walk-in centres in my constituency?

Jeremy Hunt: Exactly. My hon. Friend makes the point very well, and I will tell him something else about the hospital in his constituency. The George Eliot hospital was a failing hospital with very high mortality rates, and its deeply entrenched problems were swept under the carpet by the previous Labour Government, but this Government have turned it around and it is now a successful hospital. It is doing incredibly well because we faced up to the problems that Labour ignored.

Angela Smith: Sickness-related absence is going up around the country. In Barnsley, it has gone up by two percentage points in the past two weeks. A one percentage point increase equates to £1 million a year. Not only will that hit budgets, but it is a real sign that the NHS is under severe pressure.

Jeremy Hunt: The NHS is under pressure, so the hon. Lady will welcome the fact that Barnsley Hospital NHS Foundation Trust in her constituency has 34 more doctors and 74 more nurses, and that we are currently doing about 2,000 more operations every year for her constituents. Yes, there is pressure, but this Government are investing on the back of a strong economy so that we can put more money into the NHS and give her constituents a better service.

Barbara Keeley: rose—

Frank Dobson: rose—

Jeremy Hunt: I am going to make progress, but I will give way later.
	I want to look at the pressures that the NHS is facing, because the right hon. Member for Leigh (Andy Burnham) asked about the direct causes. There are more than 1 million more over-65s than there were four years ago. Many older people become particularly vulnerable when it is cold, which is why winters are always difficult for the NHS. The truth is that over successive decades, we have made older people more dependent on emergency care by under-investing in primary and community care, reducing the responsibility of GPs for out-of-hours care, removing the personal responsibility for patients from GPs, and failing to integrate health and social care.
	The right hon. Gentleman spoke as if that was nothing to do with Labour. However, he knows what damage was caused by the GP contract changes in 2004, he knows that his Government failed to integrate health and social care for 13 years, and he knows that where Labour runs the NHS today—in Wales—the performance is even worse. Instead of debating constructively, he chose to start this year by putting up a scaremongering poster that implied that the NHS would cease to exist if this Government were re-elected. That is not good enough. The whole country can see that, for him, it is not about the ward, but the weapon; it is not about the patients, but the politics. For this Government, it is about the patients.

John Redwood: Does my right hon. Friend understand Labour’s attack on privatisation? Under Labour, the NHS always had private-sector contractors as GPs— and nothing has changed; and it always bought all its pharmaceuticals from competitive, profit-making pharmaceutical companies—and nothing has changed. What is the shadow Secretary of State’s grievance?

Jeremy Hunt: Privatisation is one of the most pernicious fears that Labour is seeking to stoke up—not least because, as Secretary of State, the right hon. Member for Leigh allowed the decision to go through that Hinchingbrooke hospital should be run by the private sector. He has been running away from that decision faster than anything that anyone has seen before, because he is still trying to curry favour with the unions.
	The companies on the shortlist for Hinchingbrooke hospital were Circle, Serco and Ramsay Health Care. He could have stopped that as Secretary of State, but he did not. He knows—[Interruption.] Those were the three bidders for the private sector-led bids. He could have stopped that process when he was Secretary of State, but he chose not to. That makes my point very well.

Barbara Keeley: The Secretary of State and the right hon. Member for Wokingham (Mr Redwood) asked what had changed. Under Labour, we did not have tendering for £1.2 billion of cancer and palliative care services, as we are seeing now in Staffordshire and Stoke, where the majority of those tendering are private companies. We did not have that.

Jeremy Hunt: What the last Government did, which was right, was to say that—[Interruption.] I am just saying what the last Government did right. The hon. Member for Worsley and Eccles South (Barbara Keeley) might want to hear this, because I do not usually compliment the last Government.
	To bring waiting times down to 18 weeks, the last Government said that they would support the NHS by allowing the private sector to do some operations. We have continued that policy, not changed it. The result, the hon. Lady will be pleased to know, is that 6,000 more operations are happening every year in her constituency under this Government than in 2010.
	For this Government, it is about the patients. That is why we increased the NHS budget; why we hired 9,000 more doctors and 6,000 more hospital nurses; why we are doing nearly 1 million more operations a year than four years ago, with fewer long waits than ever; why we have increased cancer referrals by half, saving an estimated 1,000 lives every single month; and why we have learned the lessons of Mid Staffs by putting in place safe staffing, having independent inspections and turning around six failing hospitals.
	Patients say—[Interruption.] The right hon. Member for Leigh should listen to what patients say, because he did not do that when he was Secretary of State. Patients say that their care is safer and more compassionate than ever, with the independent Commonwealth Fund saying that under this Government, the NHS has become the best health care system in the world.

Frank Dobson: rose—

Jeremy Hunt: I give way to the former Secretary of State.

Frank Dobson: Will the Secretary of State confirm that the only reason why he has been able to recruit British doctors is that the previous Government increased recruitment into medical schools by 35%?

Jeremy Hunt: I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.
	Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.
	Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than me, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.
	It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The
	test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.

Andy Burnham: I have a direct question and I would appreciate a direct answer. If the agency bill in the NHS was the same as the one I left behind, would not the Secretary of State be able to afford the modest, below-inflation increase that the Chancellor promised to all NHS staff?

Jeremy Hunt: Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.
	I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.
	What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped in four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.
	While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!

Mark Field: Although I appreciate that there will inevitably be a battle between the two parties to a certain extent in this debate, the Secretary of State is at his strongest—this is what I hear from all the health care professionals in my constituency—when he talks about his patient-centred vision for the health service of the 21st century and when he looks away from the here and now and towards
	the future that we all know is desperately needed by all our constituents: a patient-centred NHS. I hope that he will say a little more about that.

Jeremy Hunt: I will, and that is what this is about—putting patients first. That is why we need important reforms such as ensuring that every vulnerable older patient has a named accountable doctor—I will mention that later in my remarks—and why we must remove barriers between the health and social care systems.

Hugh Bayley: It has been well known in the NHS for decades that an ageing population means that more needs to be spent in real terms each year on the NHS than in the year before. In 2010, when the Government came to power, 8.2% of our gross national income was spent on the NHS, but that has now fallen to 7.9%. How can that possibly be an increase in the Conservative party’s commitment to the NHS?

Jeremy Hunt: Because the only way we could return the economy to growth was by tackling the deficit left by the Labour party—the worst deficit in the developed world. Labour left us with that problem; we have sorted it out and are turning the country round. If the hon. Gentleman wants to increase spending on the NHS, as I do, the only way to do that is through a strong economy, which is what the Government are delivering.

Several hon. Members: rose—

Jeremy Hunt: Let me make some progress. In A and E, as in everywhere in our hospitals, it is important that whatever the pressures, people are given safe, compassionate care. Our NHS is one of the safest systems in the world, but we still have around 1,000 avoidable deaths every month. We still put the wrong prosthesis on someone once a fortnight, operate on the wrong part of someone’s body once a week and leave a foreign object in someone’s body twice a week. Just five years ago, we had the tragedy at Mid Staffs, which, we should never forget—[Interruption.] I am quite shocked that people are laughing when we are talking about harm that happens in the NHS every month and about what happened at Mid Staffs. We must not forget that Mid Staffs was hitting its A and E targets for much of the period that that same department was tolerating the most horrific care. Whatever the pressure to hit targets, the Government want every vulnerable person to be treated safely and with the highest standards of dignity and respect.
	Two years ago, we introduced the toughest inspection regime anywhere in the world. The result was over 6,000 more nurses on our hospital wards, cases of MRSA and clostridium difficile halved over this Parliament and more than 200 NHS organisations have signed up to halve avoidable harm and avoidable death over the next three years. Care is getting safer. While we lead the NHS through that painful process, what is the reaction from Opposition Front Benchers? They criticise us for running down the NHS and still maintain—as the right hon. Member for Leigh did in December—that it was a mistake to hold a public inquiry into Mid Staffs. He talked about listening to patients, but this is what someone whose mother was a patient at Mid Staffs said about his comments in December:
	“The message he is sending out is that it is better to cover things up than to criticise the NHS, however bad things are. The enquiry uncovered huge failings in the NHS and he thinks it shouldn’t have taken place at all. It is very worrying because if he becomes Health Secretary again at the election it is clear we would go straight back to the bad old days of covering up.”

Bob Stewart: One problem last month in my local hospital, the Princess Royal university hospital, was the lack of space, and ambulances were backed up. It is not just a staffing problem; it is a spatial problem. Does the Secretary of State agree that if we had more space in A and E departments, we could get people off the streets?

Jeremy Hunt: Space is a problem in some A and Es, which is why we have expanded A and E capacity. Other places have different problems, but the long-term solution is to have improved capacity outside hospitals in community care. That is the real challenge and what the “Five Year Forward View” is about.

Andy Burnham: Given what the Secretary of State has just said, may I gently remind him that I was the Secretary of State who appointed Robert Francis QC to inquire into what happened at Mid Staffs, against the advice of the Department of Health, and that report was published before the last election. If he is being fair, he should bear that in mind at all times.
	The Secretary of State reeled out a list of things that are wonderful in the NHS today—everything has got better; everything is fine; and it is the best in the world. At the beginning of the debate, I reeled off cases of people waiting hours or even dying while waiting for ambulances, or being treated in cupboards. I hope that he will not conclude his remarks without addressing the very real suffering and poor care that is happening across England right now.

Jeremy Hunt: If the right hon. Gentleman did such a wonderful job and wants to talk about Mid Staffs, why are patient campaigners so outraged by his comments and feel that he did everything he could to brush those problems under the carpet?

Alan Johnson: Will the Secretary of State give way?

Jeremy Hunt: I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.

Andy Burnham: It’s not working.

Jeremy Hunt: But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.
	The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members,
	poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.

Alan Johnson: Does the Secretary of State remember the words of Prime Minister when he stood at the Dispatch Box and presented the report from Stafford? He said that what happened at Stafford was not the fault of any previous Secretary of State, including my right hon. Friend the Member for Leigh (Andy Burnham). The Prime Minister was a statesman on that occasion; it is a shame that the statesmanship has slipped since.

Jeremy Hunt: I have a great deal of respect for the former Secretary of State, but if he had followed the debates on Mid Staffs in this Chamber he would know that my disagreement with the shadow Health Secretary is over the reaction to Stafford and whether we will learn from those mistakes. When I have made speeches talking about the problems of poor care in the NHS today, he goes straight out to the TV studios and says that that is running down the NHS. That is not acceptable when we are taking difficult decisions to turn round failing hospitals and face up to problems in exactly the way suggested by the Francis inquiry.

Several hon. Members: rose—

Jeremy Hunt: I will make some progress because I want to answer some of the questions asked by the right hon. Member for Leigh. One reason for the pressure I have outlined is that people increasingly expect to get medical care 24/7, just as they are able to bank, shop and book their holidays 24/7. The NHS cannot be King Canute and try to stop that—I am not blaming patients, but that is how patient expectations are changing, and we need to give them better alternatives to turning up in A and E.
	Over the past two years, we have expanded weekend and evening GP appointments for more than 5 million people. We have also rolled out the 111 service, which now handles—these are the facts—three times more calls every year than its predecessor, NHS Direct. The right hon. Gentleman criticised 111, so let us look at the facts. Of those who call 111, 30% say they would have gone to A and E but decided not to as a result—that is 2 million journeys to A and E and around 600,000 ambulance call-outs avoided because of 111. Unlike NHS Direct, one third of all 111 centres can now access a summary of people’s GP records, and that will apply to nearly all 111 centres this year. Not only can people talk to a doctor or nurse, as they did with NHS Direct, but if they give consent they can do something that they could never do under NHS Direct and talk to someone who knows about them and their medical history.
	Another big challenge facing A and Es is the increasing complexity of the illnesses that people are presenting with, including many older people with conditions such as dementia, diabetes or asthma. Such people often end up being admitted to hospital rather than treated and sent home, and that is not just challenging for the
	system; it is often wrong for the individual. A busy A and E can be the worst possible place for a frail, older person with dementia, which is why in our vision for the NHS every vulnerable person has a doctor who is continually responsible for their care, whether or not they are in hospital, and who ensures that they have proper care wrapped around them, thereby reducing the likelihood of emergency hospital admissions. Too often, that does not happen. Too often, the buck stops with no one. That is why, this year, we reversed the 2004 decision and brought back named GPs with personal responsibility for everyone aged 75 and over. That is helping 4.5 million people. With 800,000 of the most vulnerable people, we are going even further, giving them guaranteed rights to prompt and proactive care from their GP.
	On social care, for too long, some of the most vulnerable people in our country have suffered from disjointed care with NHS and social care systems that, rather than talk to each other, constantly try to pass the buck. For the first time from this April, we have required all local authorities and NHS organisations to work together to plan care in a joined up and seamless way, as part of the better care programme.

Diana Johnson: Will the Secretary of State give way?

Jeremy Hunt: I am going to make progress.
	When that happens, we should see, for the first time ever, not an increase but a reduction in emergency hospital admissions. For patients, that will mean something important: a doctor or nurse will be in charge of every person in the social care system; medical records will be shared, so that people get safer and more joined-up care; and joint teams will work together across the NHS and social care systems, rather than the silos and boundaries that have plague the system till now.
	The Government have never pretended that the challenges facing the NHS are straightforward, but with more doctors, more nurses, more operations and safer care than ever before, we have shown our commitment to that most precious institution. We have put our money where our mouth is, with protection for the NHS budget during cuts, financial help this winter and support for the NHS’s plan for the future. More important than the money are the values behind it: our passion for the highest standards of compassionate care for every person who needs the NHS. Good care, not clever politics, is the future for our NHS.

Several hon. Members: rose—

Dawn Primarolo: Order. I should inform Members that 28 Back Benchers are seeking to take part in the debate this afternoon. I hope that it will not be necessary to have time limits, but I ask each Member to consider speaking only for eight minutes approximately, or 10 minutes maximum. If any Member speaks for too long, it will subsequently be necessary to have a time limit, which could be quite severe on the last few speakers. That would be unfortunate, so if that could be borne in mind and if Members watched the clock, that would help enormously.

Alan Johnson: Thank you, Madam Deputy Speaker. I will do my best to comply with your instructions.
	As the Secretary of State was talking, my mind went back to the “responsible opposition” of the right hon. Member for South Cambridgeshire (Mr Lansley). I remember the efforts that went on for more than 40 years around Manchester to tackle the appalling level of infant mortality by reconfiguring maternity services. As the local newspapers said, that was stopped at every stage by politicians defending bricks and mortar. In the end, when that change went through, it was the Opposition who tried to reopen the issue. Before my noble Friend Lord Ara Darzi became a Minister, he did a very important review on London, where there were more single-handed GP practices than anywhere else in the country post-Shipman, and people attending A and E was a bigger problem than anywhere else. Lord Darzi put forward sensible proposals, which were agreed by clinicians and the NHS in London, but the right hon. Member for South Cambridgeshire opposed them. He issued an unfortunate press release about polyclinics—unfortunately, he spelt it “polly”, but it was not a clinic for parrots. I said to him, “Don’t adopt a policy that you can’t spell.” There are numerous examples of the previous Opposition doing that.
	I bet I am not the only one in this House—I bet there are Members in all parts of the House—who rues the day when the right hon. Member for South Cambridgeshire got his hands on the NHS. His ideas for what to do which culminated in the top-down reorganisation were not new—I remember them from my first day as Health Secretary. He is not a bad man who hates the NHS, by the way. In many ways, he has great affection for the NHS, but he got things totally wrong. He slung across his draft Bill on what the NHS would look like after his top-down reorganisation. I read it that evening and it was horrendous.
	The Government have done two things to erode confidence in politics in this country. The first is the Liberal Democrats’ conversion from opposing tuition fees to the extent that they wished to abolish them to supporting tuition fees to the extent that they agreed to treble them. The second is the Conservatives’ conversion from a pledge that there would be no top-down reorganisation of the NHS to the implementation of a top-down reorganisation so huge that, in the words of the previous NHS chief executive,
	“you can see it from space”.
	That is a vivid but not inaccurate description of a reorganisation that closed 170 organisations, created 240 new ones, made 10,000 staff redundant and re-employed 2,200 of them.

Julian Huppert: I will not highlight the right hon. Gentleman’s role in tripling tuition fees. The shadow Secretary of State said that, when he came into office—this is part of his defence— he got rid of the pro-privatisation agenda that he inherited. Who does the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) believe the shadow Secretary of State was criticising in that comment?

Alan Johnson: I do not understand the hon. Gentleman’s point about my role in trebling tuition fees. I certainly was the higher education Minister who introduced tuition fees, against fierce opposition. I supported them and made the arguments—all the arguments we now hear from Liberal Democrats—against the opposition of the Conservative party.
	In terms of privatisation, we did introduce independent treatment centres. At every stage, we asked the local NHS, “Have you got the capacity to get these waiting lists down? Have you got the capacity to carry out the elective surgery without denuding emergency services?” which happened all the time. Hon. Members will be surprised how many found that capacity when we said, “Okay, we’ll introduce an independent treatment centre.” Suddenly, consultants stopped going to the golf course and taking Saturdays off. They got the waiting times down. In places that did not have capacity, we introduced independent treatment centres. The role of the NHS is to treat patients, and I am very proud of the record that we and my successor, my right hon. Friend the Member for Leigh (Andy Burnham), stood on in 2010.

Kenneth Clarke: Does the right hon. Gentleman agree that, since the late 1980s, every Secretary of State from both political parties, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson), accepted that one could raise the quality of patient care by introducing competition and choice of provider in the system? The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) quite sensibly pursued that policy, as did Alan Milburn, with particular vigour, and the shadow Secretary of State when he was in office. Will the right hon. Gentleman try to encourage his successor not to go back on that, because the health service is now much better at coping with the problems of changing demand than it was 20 or 30 years ago?

Alan Johnson: The right hon. and learned Gentleman knows, because we have debated this before—I will come on to some of the history—that the big difference between what he and other Governments during the 1980s did and what we did is the single tariff. They competed on price. We had a single tariff that meant that, wherever that operation took place, it was paid for at the same rate.
	With that top-down reorganisation that we could see from space, all the Conservative party’s efforts to convince the public that they could be trusted with the stewardship of the NHS were thrown into disarray at a stroke. The fact that the NHS tops the list of public concerns as we approach a general election can be traced to that self-inflicted wound.
	The Conservative party leader’s efforts to detoxify the Tory brand vis-à-vis the NHS could be described as an attempt to return to the consensus that existed prior to the 1980s. The great historian of the NHS, Rudolf Klein, says that following its contentious birth there followed 35 years when the NHS was “cocooned in consensus”. That changed in 1982, when the Thatcher Government’s internal think-tank, the Central Policy Review Staff, produced a paper with the option of replacing the NHS, a tax-financed health service, with a system of private insurance. This option—the right hon. and learned Member for Rushcliffe (Mr Clarke)
	will probably remember this—was, incidentally, presented to Ministers not by the Secretary of State for Health but by the Chancellor of the Exchequer. It was defeated thanks to the efforts of Norman—now Lord—Fowler, but it expressed for the first time the idea that a tax-funded NHS was wrong and broke that 35-year consensus.
	From that moment, through weird and wonderful ideas, right up to 2005 when Conservatives Members stood on the platform of the ridiculous patient passport, their policy has been about taking money out of the NHS and changing the very principles of the service. I could not describe it better—I think there would be agreement on this—than the great American clinician and health care expert, Donald Berwick, who I believe the Secretary of State has used during his time in office as an adviser. He describes the NHS as
	“one of the truly astounding endeavours of modern times”
	and, in a wonderful phrase, as
	“a towering bridge - between the rhetoric of justice and the fact of justice.”
	This ideological battle is not over. Indeed, it has just been joined by the ultra-Thatcherite leader of UKIP. The hon. Member for St Ives (Andrew George) is no longer in his place, but he was perhaps right in thinking that we should get back to a consensus on the NHS.
	We could raise relevant arguments about many aspects of the NHS. Indeed, my colleagues in Hull and I are talking to the Secretary of State about some issues central to Hull. However, in this speech I do not want to talk about clinical health or the successes of the NHS. I want to talk about one of its failures. At the tenth anniversary of the NHS in 1958, there was a debate in this Chamber. Nye Bevan, the great architect of the NHS who was mentioned earlier, stood up and said what a great success it had been, but that the failure had been mental health. He spoke, using the language of the time, of the disgraceful conditions in our mental hospitals. Of course, there has been a huge improvement since 1958, but it remains a fact that mental health is a poor relation of the NHS, and children and adolescent mental health is a poor relation of that poor relation.
	I would like to cite three awful statistics published by the Office for National Statistics. First, 10% of children between the ages of five and 16—or to put it another way, three in every class—experience mental health problems. The second disgraceful statistic is that that figure rises to 60% when applied to children in care. The final disgraceful statistic is that 95% of imprisoned young offenders have a mental health disorder. Many of those young offenders should not be in prison at all. I have raised the case on the Floor of the House of my constituent, Vince Morgan, a young man with a severe psychotic illness who committed suicide in a prison cell having been failed by every single organisation and authority that was meant to help him. Section 136 of the Mental Health Act 1983 is still being used to incarcerate children, mainly as a result of the failure to provide sufficient in-patient tier 4 child and adolescent mental health services facilities.
	Forgive me for being parochial, but this is a crucial issue in our area. In Hull and East Riding, we were served well by an in-patient unit called West End for 20 years. When NHS England assumed responsibility for tier 4 services as a result of the changes from the reorganisation—all other tiers being the responsibility
	of the local clinical commissioning groups—it changed the specifications for tier 4 units, saying that they had to be open seven days a week, 24 hours a day. There was no consultation with anyone. This was done in March 2013. As West End was open only from Monday to Friday, with children spending the weekends at home—a regular feature of CAMHS treatment—the unit was closed. The option of extending the provision, so that it was a seven-day service, was never offered. Parents of children who had benefited from this important part of the NHS had no input whatever in a decision made by a huge quango that had no local accountability and no local presence. So much for the glib slogan, “No decision about me without me”.
	I raised this issue in the Chamber on 23 October. The Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, gave me a sympathetic response. I am convinced that he cares deeply about the problems of mental health, but he appears to be entirely powerless to do anything about them. Since then, there has been a review of tier 4 services by NHS England, which, as the Health Committee has said:
	“does not provide a conclusive answer on the reasons for the current problems, nor on whether there are sufficient beds”.
	In addition, that Health Committee report, published in November, pointed out that NHS England had
	“presided over a system which has resulted in children being sent hundreds of miles to access care.”
	There has been no resolution on this issue in Hull and East Riding, or in other parts of the country, such as Devon and Cornwall. We have a foundation trust provider that recognises the problem and has identified a site for a new seven-day in-patient service, but the commissioner at NHS England has yet to commission. The CCGs are powerless. The acute trust often has to open its adult wards to children.
	Let me tell the House what this means to the victims of such failure—to the children who were once so well served by the West End unit. Maisie Shaw is a 13-year-old who has had serious mental health problems since her father died two years ago. Her mother, Sally, is a teacher. Clearly, children need to be close to their family when they are undergoing treatment. Family involvement is a crucial aspect of their recovery. In December, Maisie took an overdose after breaking into a locked medication box at her home in Hessle. As it was a Saturday, there were no CAMHS staff on duty and, of course, no in-patient facility. She was taken to Hull royal infirmary on Saturday and cared for in a locked ward at the maternity hospital, with a 24-hour guard until Monday morning. She was sent to Stafford, which is almost 200 miles away, and then to Sheffield, which involves a round-trip of 120 miles by her family to visit her. As part of her treatment, she will be home at weekends, but when her mother asked what help would be available for this very disturbed child if there was an emergency, she was told to ring 999.
	The subject of my debate in October 2013 was Beth Hopper, who is now 15. Beth’s mother, Kathy, is a staff nurse for the NHS. Beth is an extremely intelligent girl who has, according to her school, huge academic potential. She suffered a severe mental breakdown at the age of 11 and spent nine months at the West End unit, which
	opened at weekends specifically to tend to her needs. Kathy believes that the unit saved her daughter’s life. Since West End closed, Beth has been sent away 19 times. She has been to Cheadle, 103 miles away. She has been to Liverpool. She has been to Warrington. She has been Nottingham. She has been Widnes. Of course, while there is no argument that to travel further for more expert care is a factor in physical health, it is rarely the case with mental health, particularly when the patient is a child. Indeed, Maisie and Beth’s clinicians in Hull often have to travel to care for her in these distant locations, thus adding to the cost of that care. It is no exaggeration to say that the condition of Beth and Maisie is actually being made worse by this treatment. It is truly scandalous.
	So that Beth’s voice is heard in this debate, I will read out a letter that she sent to her mother the other week. She wrote this:
	“I really just don’t know what to do or what I want, or what is best for me anymore.”
	Forgive her grammar.
	“I aren’t happy here. I am happy at home, but I am scared that things might go like they were before. I just want normality. I want to have the chance to be a kid for once, before it is too late. I feel as though nobody is listening to me. I am so isolated here I am scared to join the groups and don’t want to make new friends anyway. I want my old friends, who I miss.”
	We need to hear these children’s voices.

Gerald Kaufman: I am listening with sympathy and concern to the case histories that my right hon. Friend is describing. He might be surprised to learn that a constituent of mine with mental health problems was sent to Hull, without any consultation with his family.

Alan Johnson: It could not have been a CAMHS service, because we have no tier 4 service available in Hull.
	I have cited two long-standing cases from my average-sized constituency, but I have recently heard about another case—that of Jordan Hatfield, a 15-year-old who, last May, took 45 paracetamol tablets in an attempt to end her own life. She spent six days on a medical ward and has been in Cheadle for the past week. Her mother does not drive and has small children, so it is impossible for her to visit. My colleagues in east and north Hull, and across the East Riding, will have other examples, because, as the Select Committee and NHS England, in its obscure way, pointed out, there is a lack of services in this huge swathe of eastern England.
	On the wider question of mental health, we will not achieve parity of esteem by cutting funding. NHS trusts providing mental health care have lost £250 million of funding since 2012—the first fall in a decade. In addition, as my right hon. Friend the shadow Secretary of State pointed out, two thirds of local authorities have reduced their CAMHS budgets since 2010, while more than three quarters of adults who access mental health services had a diagnosable disorder before they were 18, yet only 6% of the decreasing mental health budget is spent on under-18s.
	The report of the taskforce on mental health in society, commissioned by my right hon. Friend the Leader of the Opposition, and published on Monday, has much to recommend it, particularly the right to
	mental health treatment in the NHS constitution; expansion of the enormously successfully IAPT—improving access to psychological treatment—programme; and the introduction of waiting-time standards for access to CAMHS. These are good ideas, and they need to be put into practice, regardless of which parties are in government. However, somebody needs to get a grip of this issue now. We cannot go on letting our children down in this horrendous way.

Richard Harrington: I will do my best, Madam Deputy Speaker, to stick to the eight-minute guideline—without casting any aspersion on the previous speaker, the illustrious former Secretary of State. I shall be watching the clock.
	So much has been said about the situation nationally, and I found the speech by the shadow Secretary of State, which I listened to carefully, very political, controversial and adversarial. I shall do my best not to speak in that manner. Instead, I would like Members to listen to my personal experiences in the Watford area, from speaking to people and visiting, several times, the A and E department, the general hospital, the clinical commissioning group, and so on. As a Back-Bench Member, that is about the best I can do. It is very confusing watching these tennis matches—as soon as the Secretary of State says something, the shadow Secretary of State is on television saying completely the opposite. It is confusing for people who work in the NHS and the rest of our constituents.
	As the Secretary of State said, there is unquestionably pressure on the NHS. Everybody knows that. We all know the statistics about people getting older and needing more medical care. I frequently have to ask my mother, when she phones the GP every other day, “Is it necessary?”, and I am sure she thinks it is always necessary, because when people get older, they need care, and the Government have to respond to that. However, these insinuations and open statements by the Opposition that NHS spending has been cut are untrue, and they frighten people. It is a fact—it cannot be disputed—that spending has increased in cash terms every year since the coalition came to power and by £13 billion overall, and will increase by £2 billion alone next year.
	I have spoken to consultants and nurses at Watford A and E—I have been there nearly every week since the beginning of the year—and I have seen ambulances backing up, and all the things that people on both sides of the House have mentioned. When I ask the A and E consultants why, they say, “These are not people with trivial illnesses, but people with serious concerns.” It is not a question of people with sore thumbs phoning the national number and being sent to A and E—I am certain of that, having spoken to many people in reception. We are not talking about people who should be going to see a nurse or a walk-in centre; these are serious matters, and there are a lot more of them. The extra GP hours will help, but I will come to that later.
	The Watford area is making progress, however. Northwick Park hospital has just opened a big A and E, which I am sure will take off some of the pressure; the Herts Valley CCG has had a 5.5% increase; and there are more than 1,000 extra doctors in the region since 2010—I have seen them; they are not just a statistic.
	I have spoken to them and the management. They are real people. Similarly at Watford general, we have 142 more full-time nurses. I opened a new ward last week at Watford general, and there is a £1.6 million ambulatory care unit. There are lots and lots of new things, yet Labour did a party political broadcast from Watford hospital that really annoyed the staff, the management and my constituents, because it frightened people and gave the impression that the service was disintegrating and disappearing.
	On the important subject of GPs, there is no question that it was a mistake by previous Governments to restrict GP working hours. I commend the Watford Care Alliance for being among the first to get money under the Prime Minister’s fund to finance seven-day opening for GP services till 8 o’clock, which has made a significant difference. In Watford alone, there will be 16,000 extra appointments this year, which is a lot.
	I am delighted that the Health Secretary came to visit Dr Mark Semler, whom I hope he will agree was inspirational in the way he spoke about the programme. He is a local GP who has taken this challenge on. Of course, there are big challenges with IT and explaining it to other staff in the area, but he is an inspirational man, and I think we had a constructive conversation with all the doctors about the implications of this policy. They have taken on the extra hours, and they know it is providing a service. In time, it will help significantly in providing a service to my constituents and taking some of the pressure off A and E.
	I am pleased that Watford was one of the first in the country to do that, and I think it has been a success. I know the Government’s ambition is to roll it out to the rest of the country, which would be a major step forward. The actual infrastructure—the offices, the surgeries, the premises—are there, and to anyone from a background outside the public service, it would seem strange to have all those assets and not to use them for the benefit of the customers, who, in this care, are the patients. I commend the Government for that and I thank the Secretary of State that Watford was one of the first places in the country to do this.
	Finally, I want to comment on the air ambulance service, which, as he often does, my hon. Friend the Member for Bedford (Richard Fuller) mentioned earlier. I have seen it and think the service is very impressive, and I hope the Government will consider giving it some of the LIBOR funding—it would be an excellent use of that money.

Oliver Colvile: I thank my hon. Friend for his constructive speech. It is incredibly helpful, because a lot of people get very concerned when we play “Punch and Judy” occasionally. Does he recognise the role of pharmacies, which are a key part of our NHS that we need to make greater use of?

Richard Harrington: My hon. Friend makes a good point. Some pharmacists feels under threat from internet pharmacists—not illegal ones abroad, but proper ones—but the personal contact with pharmacists and the advice they offer can provide them with an enhanced role in the internet era. So I agree with him totally.
	And that, Madam Deputy Speaker, concludes my comments.

Frank Dobson: Whatever people like or dislike about the language, I do not think anyone could deny that the NHS at the moment is struggling to care for patients in the way that the hard-working staff in the NHS would like to be able to care for them and to deal with them as promptly as they would like. Everyone recognises that the NHS is managing to cope only because of its amazingly dedicated staff doing amounts of work and quality of work far above the call of duty. I have to say that a nurse from one of the two great hospitals in my constituency, to which the Secretary of State referred, said to me, “If he says how wonderful we are and then defends us not getting a pay increase, I will throw up.” I do not think she intended doing it in front of patients, but the hypocrisy of the approach she describes seems to me to be indefensible.
	This situation is not entirely novel. A and E has been facing difficulties and has been overstretched in many parts of the country, even during the summer. That is largely because too many people are having to go to A and E or are being taken to A and E because they cannot be looked after properly at home. That is one of the main reasons. If people are kept in, there are not enough beds. I noticed that the Secretary of State quoted the King’s Fund. Having been interested in health care in London for 40-odd years, all I can say is that the main contribution of the King’s Fund has always been to demand reductions in the number of hospital beds; then, where there are not enough of them, it comes up with a million reasons why there are not enough—none of them being that there are too few beds; it is always some other factor rather than the shortage of beds itself that it manages to blame.
	The reason why people, particularly the elderly and the physically and mentally disabled, have to go into hospital is that they cannot be safely looked after at home. Once they are in hospital and occupying a bed, they cannot safely be discharged home. So, they are brought in because there is no adequate care at home, and they cannot go back out of a hospital bed because there is no adequate care at home. The Government simply cannot get away from the fact that there have been massive reductions in care at home, particularly for the elderly. Logic suggests that if there are more elderly people who are chronically ill, there should be an expansion of the service to meet the increased need. In fact, however, services have been contracting.
	The excellent work done by my hon. Friend the Member for Leicester West (Liz Kendall) a fortnight ago—just a small aspect of it—demonstrated that there had been almost 200,000 fewer people getting meals on wheels. I do not know whether the Government ever deigned to consider the impact of that, but if old people who previously relied on meals on wheels were not getting them, they were probably no longer being properly fed, and if they were not being properly fed, they were more likely to need nursing care. If no additional care was available, they were more likely to go to A and E and, once they had gone into a hospital bed, they were less likely to be safely discharged simply because they were no longer getting meals on wheels.
	The meals on wheels service does not have the function only of providing food. On every day that a person gets meals on wheels, somebody is checking how they are doing, and it gives those who are lonely some human
	contact. The disappearance of all those meals on wheels will undoubtedly have led to more elderly people having to go to A and E, and fewer elderly people being able to be treated safely at home.

Diana Johnson: I am listening carefully to what my right hon. Friend is saying. He has the perspective of a London MP. In Hull over the Christmas period, we had the longest wait for A and E in the country—and this at the same time as we have seen a quarter of the local authority budget being cut, which impacts on social care. It seems to me that the two are very closely related. Does my right hon. Friend agree?

Frank Dobson: I entirely agree with that. The fact is that the services that can be provided at home need a higher priority than they have had in the past—under any Government. They need more staff with more time, because many of the people attempting to provide a service are given a quarter of an hour to dash in, help somebody wash or cook and then dash out again to rush along to somewhere else. If one person takes up more than a quarter of an hour, they will be late for the next person they are supposed to be looking after. What is more, all these people get lousy pay. In fact, the level of pay that such people get is a disgrace.
	We also need a massive improvement in the co-ordination of services between hospitals, GPs, health visitors, nurses and the people providing those practical cleaning services and so forth. This will cost more. Anyone who pretends that we will not have to pay some more to get a service that works to replace one that does not is either just misleading themselves or—in the worst version—misleading other people.
	Previous Governments have not expanded the services in line with the need, but the recent response of this Government has been to contract the service available, which is indefensible. Proposals under the new regime—if that is the right term, Madam Deputy Speaker—have brought about fragmentation, competition and binding legal contracts between various providers of these services. If anybody thinks that will improve co-ordination, they are again either deceiving themselves or attempting to deceive the rest of us.
	In this country and in this House, we have to wake up to the fact that if we want a first-class service, we are going to have to pay a first-class fare. That was something I wrote in a long and entirely personal memorandum to the Prime Minister, not long before I foolishly resigned as Health Secretary. I pointed out that a massive increase in investment was needed. I am quite proud of some of the things I did when I was Health Secretary. That might have been the most important thing I did, because about two years later, the Government put an extra £40 billion into the health service. To be fair to the Prime Minister, I received a note from him saying, “Your long personal note triggered what we did.” I felt pretty glad about that.
	When we talk about these issues, we need to bear in mind that our NHS is easily the most cost-effective system in the developed world. The total we spend on health care is 9.4% of gross domestic product: the Germans spend 11.3%, the French 11.6% and the United States, which has an insurance system like the one the leader of UKIP wants to introduce here, spends 16.9% of their GDP on health, and life expectation there is lower than ours.
	The other really startling point, when we get people such as the King’s Fund and others demanding reductions in the number of hospital beds, is that for every 1,000 people we have three hospital beds, while the French have more than six and the Germans eight and a half. So far as I know, there is no daft consensus in either of those countries to get down to the British level.

Paul Burstow: It was a pleasure to listen to the right hon. Member for Holborn and St Pancras (Frank Dobson). I was particularly struck by the point he made about the important case for investing in our health and care system. I dare say that the note that he mentioned will in due course be published under the 30-year rule, and that we shall then have a chance to read the full text. It must be said, however, that it took nearly four years for the argument he was advancing to be understood and acted on, and that those were lost years during the a 13-year Labour Administration.

Frank Dobson: I should point out that, partly as a result of earlier negotiations, we had secured an increase of £20 billion.

Paul Burstow: I may return to that point later, but first I want to talk about my own experiences of my local national health service, and in particular about a visit that I paid to my local trust, Epsom and St Helier University Hospitals NHS Trust, at the beginning of the month. During the visit I had a chance to meet staff, including A and E staff. I pay tribute to the hard work that is done in the trust, and especially to the work that is done in the A and E department. Last week Epsom and St Helier was placed sixth among all the London trusts in terms of the time for which people were having to wait in A and E, when measured against the standard, and, according to figures that were published yesterday, 99% of people are seen within the standard four hours. That is an example of great performance. The trust is facing great pressure, but it is doing a fantastic job none the less, and that side of the story ought to be told. We ought not to focus only on hospitals that may not have learnt some of the lessons that have been learnt by my local trust.
	The A and E staff members whom I met made clear that there was no single cause of the pressures in their department. In fact, the precise mix of factors varies from one hospital to another, and from one area to another. St Helier, however, has made excellent use of the winter funding it has received. It has added capacity to A and E, and has introduced examples of good practice. For instance, there are daily reviews of patients to ensure they are being given the right treatment in the right place; patients who are ready to be discharged are identified on the previous day so that arrangements can be made in good time; and there is a system of “ward buddies”, enabling corporate staff to provide additional administration support at times of extreme pressure—such as the present time—in order to assist safe discharge. A further welcome boost is the news that an extra £325,000 has been provided to assist people’s safe discharge to their own homes or to step-down care.
	A piece of work examining the position in the Sandwell and west Birmingham area revealed huge variations between attendance rates by practice. Its authors found
	that some people considered A and E attendance to be the norm, and that a fifth of attenders made a conscious decision to go to A and E on the previous day. They also found that many A and E attenders believed that it was not even worth trying to access primary care in the first place. There are issues relating to communication, understanding of the system, and how we explain it. That cannot be dealt with in a universal, national way; it must be tailored to patients’ preferences and their expectations of the system at local level. That piece of work has already helped those in Sandwell to think about how to target messages more effectively in order to ensure that people have access to the support they need at the time they need it.

Oliver Heald: Does my right hon. Friend agree that there should be a proper investigation into winter planning in each area? As he says, factors vary greatly. In my area, for instance, the factors affecting Addenbrookes hospital are very different from those affecting the Lister hospital in Stevenage. I think that planning needs to improve. This year, the same thing happened throughout the country. The A and E departments asked for £700 million, the Government gave it to them, and yet there have been all these problems.

Paul Burstow: I think it important for the system to learn lessons from the areas where winter planning has worked well, and for us to ensure that those lessons are transferred and replicated around the country. The NHS is not always as good as it could be at ensuring that lessons are not just stuck in one place.

James Morris: Will the right hon. Gentleman give way?

Paul Burstow: I must make some progress if others are to have a chance to speak.
	The NHS has grappled with a productivity challenge during the current Parliament, but it should be noted that it was first set up and signed off by the last Administration. The target was £20 billion, and it was to be delivered within a shorter period than the coalition Government set in their 2010 spending review. The Labour productivity programme was set in 2009, and it was clear then that the NHS was on notice that it faced a very tough settlement regardless of which party was in government after the 2010 general election. Reducing management overheads has been a key part of our efforts to balance the books during this Parliament. Focusing on the management overhead costs of the commissioning side of the NHS in the legislation that went through the House at the beginning of the Parliament was sensible, and increasing clinical involvement in commissioning was another important move.

Frank Dobson: Will the right hon. Gentleman give way?

Paul Burstow: I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.
	In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result
	of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?

Andy Burnham: Will the right hon. Gentleman give way?

Paul Burstow: I will, unlike the right hon. Gentleman on many occasions earlier.

Andy Burnham: The right hon. Gentleman clearly was not listening to my speech. The central proposition is that what I described as the “root cause” of the A and E crisis was the imposition of devastating cuts in social care, which are leaving people unsupported in their own homes. Will the right hon. Gentleman now say—because he was there—that it was wrong of him and his colleagues to allow social care to be cut in that way, given that the cuts are now presenting the NHS with an enormous productivity and efficiency problem?

Paul Burstow: The right hon. Gentleman is right to raise that question. I wanted to ask him a question that relates directly to his point, and, indeed, answers it. I hope that he will agree with me—and, indeed, with the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb)—that we need a fundamental review of NHS and care spending, in the round, and that finances in that area need to be addressed before the spending review that any Government will carry out later in the year. We need to ensure that we are clear about the level of investment that will go into our health and social care system. So far, I have heard no clear indication from the right hon. Gentleman of his relative spending priorities when it comes to health and social care, and they need to be made clear if we are to establish a consensus.

Andy Burnham: Will the right hon. Gentleman give way?

Paul Burstow: I will give way once more, but then I must make rapid progress.

Andy Burnham: My answer to the right hon. Gentleman’s question is that I want a single service: a single service for the whole person. I want a national health and care service. We should no longer have two budgets; we should have a single budget, and we should then use the money as best we can to support people, starting in their own homes—and we are going to invest an extra £2.5 billion.
	The right hon. Gentleman did not answer the question that I asked him. I asked him whether he and his Government colleagues, in those early days, made a mistake in allowing social care to be cut to the bone? Every week I am accused of saying that it is irresponsible to give real-terms increases. The right hon. Gentleman allowed social care to be raided. Should we not receive an apology for that today?

Paul Burstow: Let me deal quickly with that and then come on to what we need to do next.
	As a result of the 2010 spending review, we invested £7.2 billion extra in social care over the life of this Parliament. I regret the fact that not every local authority has fully spent that resource on social care, and although the right hon. Member for Leigh (Andy Burnham)wants to make this an issue of blame I want to try to try to analyse the problem. It has already been said that some local authorities have struggled purposefully to reorganise their services to make the best use of the resources available and have delivered better outcomes, not least by investing in services such as re-ablement, which significantly reduced the call on ongoing care services.
	It was right for the Government to put the resources in and make the commitments we did and it was right in the autumn statement this year to commit the £2 billion for the NHS as a down payment to deliver Simon Stevens’ NHS Forward View. Although that is good news, I want to flag up a couple of concerns. First, there needs to be clarity about the funding commitment in every subsequent year during the course of the next Parliament. We have had some indications from the Labour party and some from the Liberal Democrats, but we have not yet had clarity from the Conservatives about how they would address the £8 billion gap.
	Secondly, despite the commitment of £7.2 billion for social care during this Parliament, not all that money has got through to social care. I acknowledge the efforts that councils have made already, but we cannot ignore the fact that social care has been a poor relation of the NHS not just during this Government’s lifetime but under successive Administrations of parties of both persuasions over a very long time. I have asked the Secretary of State to ensure that social care benefits from some of this £2 billion and urge him again today to do just that. It is unacceptable that some councils are paying fees for care that condemns staff to rates of pay below the national minimum wage and it is no wonder that as a result we have among the highest staff turnover rates of any part of our economy and that it is so difficult to recruit.
	To conclude—although I could go on a little longer—I want to address the comments made by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). In a debate that had been about much heat but not a great deal of light, he cast important light on one of the key challenges for whoever is in government after the election, which is how we ensure that we reform our mental health care system to deliver the parity of esteem the Government have set out as an ambition and have started down the road of delivering. We still have a long way to journey, however.
	We still have a separation in our health care system between the service that delivers for physical health and the service that delivers for mental health, yet those two things are inextricably linked. We know that half of lifelong mental health problems start in adolescence and need to be addressed at that point. The goal of parity of esteem, which is shared across the House, is right. We need parity of esteem in outcomes, rights and resources and I welcome the investments made by the Government, the commitment to continue the improving access to the psychological therapies programme that was started by the previous Government and has continued under this one, the launch under this Government of a
	children and young people’s IAPT programme and the emergency care concordat. I thank the Minister of State, who is on the Front Bench today, for launching the children and adolescent mental health services review, which must provide a route map for reforming CAMHS for whoever sits in the Secretary of State’s office after the general election. If it does not, it will have failed in its task. We need a plan and we need that plan to be implemented through the spending review after the general election.
	The debate has highlighted yet again that we are yet to reach consensus in this Chamber on how to improve our NHS. There are people of passion and commitment on both sides of the House who have in their heart and at their core a desire to maintain a national health service that is free at the point of use and available on the basis of need. We need to extend that to ensure that our social care system is no longer left behind in the way it has been by successive Governments.

Several hon. Members: rose—

Lindsay Hoyle: Order. Speeches of up to eight minutes would be helpful if we are to try to get everybody in—do not worry, you did very well, Paul.

David Lammy: Two years ago, a friend of mine collapsed on a football playing field and an ambulance was called. The ambulance should have reached this major emergency within eight minutes, but it took 17 minutes and my friend died of a heart attack on that field. The seriousness of this debate for many families beyond this Chamber—I am thinking of the wife and three children that he left behind—cannot be conveyed. It is right to begin by saying that the £700 million that has been found and the £150 million for the challenge fund are absolutely desirable and necessary at this time. I remember, as a former Minister in the Department dealing with the winter crisis, that those funds are very important.
	I want to take the House back to a dark time for the NHS, when it was routine to wait in A and E for six, eight or 12 hours, and to what it took to change that system. It was a great privilege for me to begin my ministerial career in the Department of Health. The then Member for Darlington was busy, controversially, dealing with foundation hospitals. The then Member for Barrow and Furness was busy at that time, controversially dealing with nurses’ pay and increases we wanted, and with the GP contract. I found myself leading on emergency care, and I was the Minister who took through the changes for that A and E target.
	We brought in Professor Sir George Alberti. For a number of reasons, it was hugely important that we had a clinician leading the charge across the NHS. We needed to persuade the GPs about access if this was to work. We brought in the target—48 hours, since abolished —and a lot of practice at the front door of A and E. The phrase we used all the time at that point was “See and treat and triage”, but it worked only if we looked at the system as a whole system. Important targets in the rest of the hospital—in cancer, in cardiac care—were necessary. Frankly, it is a crying shame that seven of the 15 major targets were missed under this Government.
	We also needed to deal with social care, of course. If £3.53 billion is taken out of social care, there must be consequences. We should remember that much of this debate has been in the past tense. There are further cuts to come, with day centres to be closed. We see phrases pop up in local authorities such as “New pathways for the elderly”. New pathways to what? New pathways to isolation; new pathways to falling over at home alone; new pathways to going without food; and new pathways to ending up at the door of A and E.
	We also introduced NHS Direct to ensure that nurses could deal with calls promptly and move on. I never conceived that we would get rid of the nurses in NHS Direct, and that we would move solely to a system of algorithm. Is it surprising that NHS Direct staff are directing people to the door of A and E? Our system worked because before people went to A and E they could go to a walk-in centre. We can call them urgent care centres if we want, but they are essential—they are part of the triage, a part of the see and treat method that we need. Again, however, one in four of them have been lost, resulting in the crisis we see before us.
	Here in London it is worse, because we are losing A and Es—gone at Chase Farm, gone at Hammersmith, gone at Central Middlesex, going perhaps at Epsom and St Helier, gone at Charing Cross—and with a population rising to 10 million. This is a serious debate because it is about to get worse. No wonder the chief executive of the London ambulance service resigned yesterday. She is leaving a sinking ship under this Government’s watch, and this House and the people will remember that, because it is specious of the Secretary of State to come to this Chamber and say the debate is solely about more nurses and more doctors. It is not. It is about the system—the NHS.
	Who is accountable under this new structure? Is it NHS England? Is it the CCGs? Is it the CQC? Is it another jargon organisation? No one is responsible—certainly the Secretary of State is not, because he gave up those responsibilities in 2012. That is the mess this Government have got into without even putting it in the manifesto. It is a disgrace.

David Davies: I would like to tell the House what I think is an absolute disgrace. Not once during the speech made by the Secretary of State for Health, not once in any of the speeches made by Opposition Members and not once in Welsh questions earlier today did any Opposition Member raise the issue of what is happening in the national health service in Wales. Labour has been responsible for the health service in that part of the United Kingdom for the past 16 years, and Labour Members are running scared of making any mention of it or drawing any comparisons involving it. According to a House of Commons Library document—and they don’t come much more neutral than that—the NHS in Wales, run by Labour, is doing far worse than the NHS in England on almost every measure.

Andrew Gwynne: I do not know whether the hon. Gentleman was present for Welsh questions earlier; I certainly was. Perhaps he was asleep, because the shadow Secretary of State for Wales, my hon. Friend the Member for Pontypridd (Owen Smith), used three of his questions to the Secretary of State to ask specifically about the NHS in Wales.

David Davies: I checked the Order Paper this morning, and no one had tabled a question about the NHS in Wales.
	The shadow Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), said earlier that he was not responsible for Wales, but the reality is that there are 20,000 patients in England who are registered with Welsh GPs and who have their health care provided in Wales. The right hon. Gentleman is, to some extent, responsible for the poor level of service that those people are currently receiving.

Clive Efford: Will the hon. Gentleman give way?

David Davies: I am happy to give way, but I have to say that Opposition Members have used up rather more of their allocation than Members on this side.

Clive Efford: The hon. Gentleman seems to be talking about records. This Government came in with no mandate whatever and planned to close nine of the 31 accident and emergency departments across London. What state does he think the A and E service in London would be in if his Government had been successful in every case? They were prevented from achieving their aim by public campaigns, including the one in Lewisham, in my part of London.

David Davies: I am absolutely certain that the A and E situation in England would be far better under this Government than it is in Wales, where, according to the House of Commons Library report, 13% of patients in major departments wait more than four hours in A and E. That is approximately double the percentage recorded by major departments in England. The question of ambulances has been raised several times today. Wales has the worst ambulance response rate in the United Kingdom, with around 55% arriving within eight minutes, compared with more than 70% in England.
	The shadow Secretary of State talked about privatisation, but it was the Labour Government who, quite rightly, started using the private sector to improve the national health service. I have here a quote from the Labour Secretary of State in 2002; I will not mention his name. He said of the private sector that
	“we intend to use it when it can bring expertise or resources to help improve services.”—[Official Report, 26 February 2002; Vol. 380, c. 547.]
	We have carried on doing the same thing. A few years later, a different Health Secretary said:
	“The NHS has always made use of the private sector and will continue to do so”.—[Official Report, 25 October 2005; Vol. 438, c. 163.]
	She also promised that, the following year, patients would be able to choose from any health care provider—NHS or independent sector—that met NHS standards.
	It was Labour’s policy in government to use the private sector. There is nothing wrong with that, but it is totally ridiculous for Labour Members now to pretend that the Conservatives are trying to privatise the NHS. That is a big lie: we will never, ever privatise the NHS, but we are quite happy to use the private sector when it can provide a better service, just as the Labour Government
	did. The last word on this came in 2005, when Professor Allyson Pollock wrote a damning book about the privatisation of the national health service. She was criticising the Labour Government.

Oliver Heald: Does my hon. Friend agree that Labour took things a bit too far? The shadow Secretary of State tendered out the Hinchingbrooke hospital, which ended up in the private sector. That has not been a success, and I think it is better if a trust runs the hospital—

Andy Burnham: I did not do that.

Oliver Heald: Oh yes he did!

David Davies: I agree with my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald). The reality is that Labour Secretaries of State said over and over again that they were quite happy to use the private sector, and they did. They were probably right to do so in many instances, and we have continued to do so. There has been no departure from that policy.

Andy Burnham: On a point of order, Mr Deputy Speaker. I have always to correct the record when these statements are made. I apologise for delaying the House, but I am going to carry on doing it. I did not put it out to tender; it was a process I inherited, and in the middle of that process I changed the policy from “any willing provider” to “NHS preferred provider”. Contrary to what the Secretary of State said at the Dispatch Box, NHS Peterborough and Stamford was still in the race.

Lindsay Hoyle: You have certainly corrected that. It is a point of correction, rather than a point of order. It is all on the record now and everyone can continue. Let us see whether we can turn the heat down a bit.

Oliver Heald: Further to that point of order, Mr Deputy Speaker. I just do not accept the point of order that the shadow Secretary of State has made. May I just—

Lindsay Hoyle: Order. No—I said straight away that it was not a point of order, but a point of correction. The point is that it is all on the record for people to read tomorrow, to continue a debate on who is right and who is wrong. Both parties, quite rightly, have stated what their belief is. Mr David T.C. Davies has not much time to go and I am very worried that he will not get to the end of his speech. He has only eight minutes in total.

David Davies: Thank you, Mr Deputy Speaker. I am grateful, because I want to talk about quite a few other things. We did not hear very much about waiting time comparisons, but of course the waiting times in England and Wales are very different. In Wales, people wait at least 26 weeks, with 14,745 having been waiting for more than nine months for treatment; in England, people wait about 18 weeks. One hundred and fifty people have died in Wales waiting for cardiac surgery.

Norman Lamb: My hon. Friend mentioned Professor Allyson Pollock. Is he aware that she particularly highlighted the extraordinary amount of money spent under the previous Government on the private finance initiative, mortgaging the future of the NHS to the tune of more than £80 billion? In the course of the next Parliament, that will cost more than £11 billion.

David Davies: I commend the professor’s book, and I hope Labour Members read it, as well as looking at the NHS comparators between England and Wales, which they obviously have not done so far. I would like Labour Members to tell us whether—if they ever are in government; I hope they will not be—they will guarantee to continue with the cancer drugs fund, which has allowed thousands of people in England to live longer and more productive lives than they otherwise would have.
	The situation is not the same in Wales, where these cancer drugs are routinely denied to people. I am talking about people such as my constituent Ann Wilkinson, who is also trying to care for a very ill husband but who has been denied Avastin. She has had to find other means to get it, and other seriously ill people in Wales have had to move to England or find people’s spare rooms to sleep in.
	We heard something about cuts, but the reality is that we have guaranteed the NHS budget in England while it has been cut by about 8% in Wales. Thousands of people are members of Action for our Health, a group comprising people campaigning in Wales to be treated in England. Some people say that the NHS is the envy of the world, and perhaps it is, but the NHS in England is very much the envy of Wales. To see that we need only ask the thousands of people—ordinary patients—in a campaign group who want to be treated by the NHS that is run by this coalition Government and not by the NHS that is run by Labour.
	I wish to finish by saying to my right hon. Friend the Minister that I congratulate him on the better ambulance response times he is delivering in England than Labour is delivering in Wales; on the better accident and emergency turnaround times he is delivering in England than Labour is delivering in Wales; on the shorter waiting lists in England than people face in Wales; and on the cancer drugs fund, allowing people to live longer in England than they otherwise would in Wales. Most of all, I congratulate him on protecting that NHS budget—on standing up for the NHS instead of cutting the budget, as the Labour party has done in Wales. I very much hope that he is able to continue with that good work in years to come.

Stephen Hepburn: If anybody wants to see the direction in which this Government are going with the NHS and what impact their policies are having on it, they should come up to my constituency.
	Let us think back to the Prime Minister’s weasel words before the last general election—that the NHS was “safe” in his hands and that he wanted the initials NHS to be synonymous with and to define his name. Then let us look at what is happening today. It is a wonder he can lie in bed straight at night, as we see the
	NHS in crisis—the only thing it is doing is crying out SOS. He promised that there would be no reorganisation, but what do we get? We get the biggest reorganisation since the NHS was formed, and one set up for one thing and one thing only: to privatise the NHS. Some £3 billion has been spent on that reorganisation and the bill is going up—£3 billion that should have been spent on the sick instead of on P45s going out to thousands of nurses when cuts are implemented. It is disgraceful.
	Ministers have only to come to Jarrow to see what is happening. In my local hospital three elderly patients wards have closed, a minor injuries unit has closed and now, to make matters worse, a popular walk-in centre, which sees over 27,000 patients a year, is to close. The closure is opposed by everybody in the area—the council, the trade unions, the patients and the staff.

Jim Cunningham: Has my hon. Friend noticed that the Government are running true to form, like the previous Conservative Government, when we had bed blocking and people sleeping on trolleys because they could not get a bed in hospital? Has he noticed particularly that local authority budgets could have provided for the elderly and prevented bed blocking?

Stephen Hepburn: That is exactly the point that the shadow Secretary of State made in his opening speech.
	As we heard earlier, local managers are not listening. They are stooges of the Government and they are carrying out the cuts without listening to local people. It is disgraceful. They are not incompetent, and nor are the Government—they know exactly what they are doing. There is a deliberate effort to sabotage the NHS by piling those 27,000 patients a year on to the local doctors.

Andy Burnham: I am listening carefully to what my hon. Friend says. His walk-in centre, like mine, was one of the first to open and is greatly valued by the community. I make this offer to him today: if he and his community can keep the campaign going and keep that centre open, and if I am the Secretary of State in May, it will stay open for good.

Stephen Hepburn: I am sure people in the area are extremely grateful for that statement of support and commitment and that pledge from the shadow Secretary of State. I only hope he will become Secretary of State.
	The Government and the management of the NHS are not incompetent. They are acting deliberately. The 27,000 patients in Jarrow who now go to the walk-in centre will have to go to the doctors’ surgeries, where it is difficult enough already to get an appointment. That will only exacerbate the problem. When they go down to A and E, which is doing a terrific job, the situation will only get worse. The Government know exactly what they are doing. They are trying to sicken people of the NHS so that they can turn round and say, “The NHS is not working. We will bring in the private sector to help out and to take it over.” That is the policy of this Government.

Steven Baker: Under the previous Government, my predecessor was not able to prevent the closure of A and E. If Labour is in government,
	I shall remember his speech today and the promise that was given to him, and I shall watch closely what happens.

Stephen Hepburn: I can assure the hon. Gentleman that after that pledge I will certainly be watching the shadow Secretary of State when he gets in, to make sure our walk-in centre is still going.
	Who gains from the present situation? Only two lots of people—the Tories, many of whom are up to their necks in involvement with private health care providers, and the profiteers, the health care providers, who are going to come in and cherry-pick the best services so that they can make profits. I welcome the shadow Secretary of State’s statement and commitment today. It will boost the morale of the people of the north-east who are so desperate to keep the service.

Rehman Chishti: The hon. Gentleman just asked the shadow Secretary of State whether his walk-in centre would be kept open and the answer was yes. However, we should not look at future promises. We should look at the past and what was done under the previous Administration. In 2006, Medway hospital in my constituency had the seventh worst mortality rate, yet nothing was done. We must judge Labour by what it did, not by future promises.

Stephen Hepburn: We must remember that it was the Labour party that created the NHS, that saved the NHS in 1997 and that tripled spending on the NHS in our last period in government. It is the Labour party, when we get in, that will return the NHS to the people—unlike the Tories, who would return the NHS to the profiteers who fund them and their organisation. The only way to get rid of the crisis in the NHS is to get rid of the Tories.

Stephen McPartland: I am proud of the NHS and I am proud of its staff. The Lister hospital in my constituency is very large and employs thousands and thousands of staff who, I am proud to say, save lives on a daily basis. The hospital is one of the NHS’s big success stories, as it is currently undergoing a £150 million redevelopment.
	I spend a lot of time at the hospital, because I am always opening things and looking at new plans and buildings, which include a new endoscopy unit and theatre, a new A and E unit and a new theatre and ward block, none of which have as yet been fully opened. I have opened a variety of other units, including new scanning units. Some £150 million has been invested in the NHS in Stevenage, which is the biggest ever investment in the NHS in Hertfordshire’s history. As the county predates the Norman Conquest, Members will understand that that is a pretty big investment.

Oliver Heald: I congratulate my hon. Friend on the investment and the fantastic facilities of his hospital. In my neighbouring constituency, we say that if someone wants to find the Lister hospital, they should look for the cranes, which are there for the construction of all the new buildings. Does he agree that it has taken a Conservative-led Government to make those improvements?

Stephen McPartland: My hon. and learned Friend is correct, and he supported me all the way as I fought with the Treasury, the Department of Health and every single system to ensure that we got the deals signed, sealed and delivered and the buildings constructed on time. I am proud of the investment and the staff who work in the hospital, but I am concerned about the way that Members talk down the NHS. Thousands of NHS workers in my constituency feel very depressed about the situation. They put in a huge amount of hours and a great deal of effort, and what happens at the end of the day? People say that their A and E is in crisis. That is completely unacceptable. Last week, the A and E department in my constituency saw 93.7% of people within the four-hour target. This week, it is on target, with nearly 95% of people, which is down to those doctors and nurses working their backsides off on a daily basis to ensure that they save lives.

Rehman Chishti: I pay tribute to the work my hon. Friend does in his constituency. I often see it on Facebook and read about it on the internet. He is a tireless campaigner for the health service in his constituency. He mentioned the A and E in his constituency. A linked issue is that of resources. In my constituency, £13.4 million has just been invested in resources for the A and E department—

Lindsay Hoyle: Order. I do not want such long interventions. If the hon. Gentleman wishes to speak, we can always put him on the list. If he wants, he can save something for later.

Stephen McPartland: My hon. Friend makes a fantastic point, and he is a fantastic campaigner, too. I am sure that that money would not have arrived without a huge effort on his part.
	The Leader of the Opposition was in my constituency last week, and we were grateful to him for his visit. He came and celebrated the £150 million investment that I had secured for my hospital. He can come as much as he likes, because I got more donations, supporters and volunteers from his visit. Perhaps he could come on a weekly basis. Incidentally, let me talk about the Lister treatment centre, which the right hon. Gentleman visited. It was privatised under the previous Government. I ran an 18-month campaign to have this private facility returned to the NHS, and I succeeded. I am probably the only Tory MP in history who has managed to renationalise a part of the NHS that had been privatised under a Labour Government. I worked very hard on that campaign, but it was lonely work. The local Labour council did not back me; the local Labour candidate did not back me; the Labour shadow Secretary of State did not back me; the Leader of the Opposition did not back me; but the GMB union did and for that I am very grateful.
	Three people died in that facility and 8,500 patients’ records were lost. It was a complete and utter shambles. Clinicenta Carillion, the organisation that was responsible for running that facility, destroyed the lives of thousands of people in Hertfordshire; that must never be repeated. That is what we talk about when we talk about the NHS. Who did I stand up for? I stood up for the patients, for the staff and for their families. Where did I get my information from? From members of staff who
	were working in that facility daily, under huge pressure, suffering and working as hard as they could to provide the best service they could. They could not do it, because their hands were tied behind their back—the contract was so bad. The local hospital was not even allowed sight of the contract until it was signed, sealed and delivered by the previous Government. They did not even know what they were being signed up to, which is a disgrace. I am proud of my hospital and the staff who work in it, but we must always remember that, at the end of the day, these are human beings, who are working incredibly hard to deliver real improvements in services.
	Fortunately, that facility is being handed back to my local hospital. The Secretary of State for Health worked with me. He allowed me to come and see him, and we had a variety of meetings. I argued with the Care Quality Commission. I was very lonely throughout that campaign, but at the end of the day the Secretary of State worked with me and he nationalised that private facility, which the previous Government—disgracefully—privatised. I am proud of the Secretary of State, and I am only sorry that he is not in his place, because I wanted him to come and open one of our wonderful new facilities in February. The Prime Minister can come in March.
	The facility that I was discussing got so bad that GPs lost confidence and wrote to each other saying, “Do not refer patients to this facility or you will put them at risk.” The CQC started proceedings to revoke the licence. That facility was falling apart—a facility that was privatised by the previous Government. It was nationalised by the Conservatives.
	So I am proud of the NHS and proud of the staff who work in it. I am proud of the £150 million development in my constituency, which is making my hospital one of the most modern facilities in the UK. I am disgusted that the Leader of the Opposition wants to weaponise our local NHS and never once backed my campaign to bring that shameful private contract back to the NHS. The Labour party should apologise to my local community for playing Russian roulette with our local health service and politics with my constituents and patient safety.

Alison McGovern: It is a pleasure to follow the hon. Member for Stevenage (Stephen McPartland). I listened carefully to his speech. He has very good taste in one respect—the football team that he supports. Although he praised the NHS staff—of course, the NHS staff I represent and speak to work incredibly hard; I pay tribute to them—in almost everything else he said, he could not recognise the glaring fact of the reorganisation being the root cause of some of the problems that we are seeing, and he was wrong in his assessment of the shadow Secretary of State’s contribution. The NHS is an extraordinarily important issue to us all. Opposition Members show great passion, as the hon. Gentleman did, and we would all pay tribute to the hard work of NHS staff. There is no difference between us on that point.
	I commend the speech by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), who is not in his place at this moment. I was particularly moved by his recounting of the experience of his constituents—teenage girls suffering from mental
	health conditions. It is what the House of Commons should be there for, to allow us to hear his constituents’ voices in that way. I would hope that, in our debates on mental health, we can do much more to bring those problems in our system to the fore.
	I want to talk about what I see as three possible solutions to the current difficulties and crises in the NHS.

Ian Austin: Vote Labour, vote Labour, vote Labour.

Alison McGovern: My hon. Friend makes an excellent point, but I want to outline some of the specifics that might be entailed by that position. I want to talk about three elements of changing the NHS that I take to be very important. One of them is pretty parochial, but the other two are terribly important for our whole country.
	The first concerns a walk-in centre in my constituency. Not everybody in the House will be an expert on the geography of Merseyside and, specifically, the Wirral, though I know that everybody will appreciate how important it is that they learn about it. In my part of the world, our local hospital is quite far from those of us in south Wirral. There was a hospital in south Wirral called Clatterbridge hospital, which I was born in. Its emergency facilities closed many years ago; I think that I was almost one of the last babies to be born there. Services were moved up to Arrowe Park on the border of the Birkenhead and Wirral West constituencies. I well remember, when I was young, how far away Arrowe Park felt and, when members of our family were ill, what a long distance it seemed when getting there.
	Under the previous Labour Government, with my predecessor’s support, Eastham walk-in centre was opened in south Wirral, near the Cheshire border. That walk-in centre has been a rip-roaring success. It treats people effectively. They can turn up at hours that are convenient, such as out-of-work hours. It is open at the weekends and until 8 o’clock at night on a weekday. I declare an interest as a parent of a young child who always seems to manage to get herself unwell at the most inconvenient times. Eastham walk-in centre has been there for us, and my constituents value it greatly.
	Under the reorganisation, the new clinical commissioning group took over. In Wirral, we had a bizarrely complex structure of three federated CCGs for a population of about 350,000. Having three CCGs in Wirral was total madness. Twenty-five million quid was wasted on a reorganisation that nobody wanted and nobody voted for. The first thing the CCG wanted to look at was urgent care, and it put our walk-in centre under threat of closure. This is an incredibly important facility to the people of south Wirral. It brings the NHS to their doorstep. It totally changed the availability of out-of-hours facilities for people in my constituency. The CCG, in its lack of wisdom, thought it was just fine to say, “We’re not sure we need that. We can re-provide those services at GP surgeries, never mind whether they are open at a convenient time.”
	The CCG never went through with those proposals, and rightly so. Since then, however, there has been a constant threat and a worry in my mind about Eastham walk-in centre. I want to make it clear to the Minister that if there is any risk at all of that walk-in centre closing, he will receive representations from me pretty
	quickly, because it is an absolutely vital service. Unless we again conceive of the NHS as being there for patients and the public first and think about how to bring these facilities close to people, we will never get an efficient and effective service fit for the next generation. Walk-in centres are absolutely vital. It sends a chill down my spine to hear the shadow Secretary of State say that one in four has closed; if anything, we should be opening more.
	Secondly, I want to talk about social care and older people. We all know that we have the benefit of an ageing population in our country. With an older population, we will have a more experienced and expert population. I take it to be a good thing that people’s grandparents and valued members of their family are living longer, but with that comes a responsibility to look after them properly.
	I ask Ministers what has happened to the better care fund. What evidence is there that it has been used to find solutions that are really working? All I see on my patch is council cuts and then the consequences turning up at the door of the hospital. Older, more seriously ill people in our community are turning up at A and E, with the distress to them of being there, the consequential responsibility on staff and the worry for families as people lie on trolleys.
	We need a much more radical approach. Integration is clearly the answer, but I would like us to go further: I want us to truly address the work force issues in social care. It is not good enough that poverty pay is endemic among those who look after the most senior members of our community. That is not acceptable; nor is the zero-hours culture. We once had that problem in child care, but as a country we took on the responsibility of changing the culture in the work force for the good of our children, and we must do the same for the benefit of our older people.
	I will not speak for much longer, Mr Deputy Speaker, but I want to say something about mental health, which should be part of the strategic approach that we must take to change the NHS for the benefit of the next generation. Parity of esteem is of course correct and absolutely right. I take it that there is now cross-party consensus on that issue and that everyone in the House thinks that we should treat mental health as seriously as we do physical health, with no barriers to getting proper treatment. However, I want us to do something else: we need to recognise the interconnected nature of physical health and mental health. It is not just that we also need to treat mental health, but that if we sort out people’s mental health issues and conditions and empower them to live better and happier lives, they will have better physical health and will make better use of the NHS’s scarce resources.

Chloe Smith: I warmly welcome the hon. Lady’s last point, but why did she not prevail on her Front-Bench colleagues to include it in the motion?

Alison McGovern: I have many conversations with my right hon. and hon. Friends on the Front Bench, but they do not always ask me for a full briefing before they draft their motions, as I am sure the hon. Lady appreciates.
	I conclude by saying that with the appropriate use of walk-in centres, a radical approach to social care and real consideration of the interconnections between physical and mental health, the difference we can make to our NHS will be excellent.

Chris Skidmore: I thank the Department for recent rises in health care funding in South Gloucestershire. Only yesterday, I received a written answer to a parliamentary question showing that South Gloucestershire CCG will receive £263 million for 2015-16, which is up from £249 million in 2014-15 and from £239 million in 2013-14. That 7% increase in per person funding, from £921 in 2013 to £997 today, is the 16th largest rise out of 211 CCGs. Tomorrow, I will attend the opening of the Leap Valley medical centre in Emersons Green, which is a brand-new, multi-million pound GP centre for the benefit of my constituents in Downend and Emersons Green. Things are therefore looking up for NHS funding in South Gloucestershire and Kingswood.
	I was pleased to have a meeting with the Chancellor at which my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) and I convinced him to give £1 million from LIBOR funds to the Great Western air ambulance, about which the chief executive has said that he is absolutely delighted. As the local MP, I have been pleased to be able to push for such improvements in health care.
	I want to raise my concerns about the health care situation in Bristol, particularly in relation to Southmead hospital, a brand-new hospital under a £500 million private finance initiative contract that was signed and sealed under the previous Government. As a consequence of the opening of Southmead hospital, Frenchay accident and emergency was closed. It is no coincidence that Southmead has struggled since that closure. As a candidate and as an MP, I fought to keep the A and E open, after the decision to close it was taken in the Bristol health services plan for 2004 to 2006.
	I still believe that the closure of Frenchay A and E was an absolute disgrace for our local community. We all know that it happened when the local North Bristol NHS Trust decided to prioritise Southmead over Frenchay because Frenchay’s more expensive land could be used to build a housing estate. We are now seeing the consequence of the reorganisation that took place under the previous Government. It happened despite the fact that 50,000 people signed a petition to get the then Secretary of State, Patricia Hewitt, to refer the decision to the Independent Reconfiguration Panel, which she refused to do. It was a total mistake for the previous Government to decide to prioritise Southmead over Frenchay.
	Cossham hospital, another hospital in my patch, was threatened with closure in 2004. The Save Cossham Hospital campaign group was fantastic in opposing that potential closure by the health chiefs of North Bristol NHS Trust as part of the disastrous Bristol health services plan. As a result, Cossham hospital has had a £19-million refurbishment and looks fantastic. I believe that the shadow Secretary of State visited it a couple of months ago.
	However, there is a gaping hole, because the minor injuries unit that was promised for Cossham hospital is yet to be delivered. Along with all the parties and the
	fantastic Save Cossham Hospital group, which is led by Reg Bennett, we have collected well over 17,000 signatures to call for the minor injuries unit. I have secured several debates in Parliament, as the Minister well knows, to call for a Cossham MIU. Regardless of the status of the minor injuries unit, we were promised it because Frenchay A and E was closing. That decision was taken by the previous Government, as I said, and the final contracts were signed in February 2010.
	Having been promised this health resource in Kingswood after Frenchay A and E closed, we deserve to get it. It is too far to get round to the other side of Bristol and there are no proper bus services to Southmead hospital. We must remember that NHS services are funded by the taxpayer, so every taxpayer deserves equitable treatment and access to local health care services. I do not believe that my constituents are getting that because Frenchay A and E has closed and Southmead is too far away. We need our minor injuries unit at Cossham hospital.
	Only today, there was a meeting of the public health and health scrutiny committee of South Gloucestershire council. On 19 November, I spoke at the committee in person to call for the decision about the minor injuries unit to be referred to the Secretary of State. The committee agreed in principle. I contacted the Department this week, having had regular meetings with the Health Secretary to discuss Cossham and Frenchay, only to find that no letter has been sent by the committee to the Health Secretary. The Department of Health simply has not received such a letter. Today, it turns out that the committee is yet to refer the decision to the Health Secretary. Without that official referral by the committee, the Health Secretary cannot refer the decision to the Independent Reconfiguration Panel.
	I call on South Gloucestershire’s public health and health scrutiny committee to get a move on, pull their finger out and send the letter to the Health Secretary. I hope that Ministers will confirm that once they receive the letter, they will be able to refer the decision about Cossham minor injuries unit to the Independent Reconfiguration Panel. It is simply not good enough for the committee to have this month-on-month delay without sending the referral letter to the Health Secretary. People in Bristol have waited too long. They saw Frenchay A and E close, which was a disgrace and will always be Labour’s worst legacy in my local area. We need the minor injuries unit at Cossham hospital and I will continue to fight for it every single day.

Gerald Kaufman: The national health service is, without doubt, the most precious asset this country possesses. It was created by a Labour Government against, as we should recall at all times, the votes of the Conservative party in this House of Commons.
	The Minister who created the national health service was Aneurin Bevan. He did so by immense negotiation, including with the British Medical Association, which he got on board to support and participate in it. As well as having administrative abilities and abilities of persuasion, Nye Bevan was the greatest orator I have ever heard. I met him on a number of occasions and heard him speak. I remember one speech that he made at Labour party conference when a Conservative Government were in power, in which he said of a Minister, “The Marquess
	of Salisbury has an ancient lineage. It is almost as old as the Poor Law itself.” Nye Bevan would be horrified that in far too many ways, the national health service has descended to Poor Law levels.
	Margaret Thatcher said:
	“The National Health Service is safe in our hands.”
	This Government’s hands are throttling the national health service. Under this Government, the NHS has had an extremely costly reorganisation that cost £3 billion and provided no benefit at all.
	A recent survey of GP services—we all rely on our GPs; heaven knows that I would not be standing here today had it not been for my GP referring me to the national health service—showed that ratings have declined for every aspect of trying to see a GP, including opening hours, waiting for an appointment, and waiting in the surgery. Looking at causes, it pointed out that general practice has had its funding reduced over the past five years, and it is five years since this Government came to power. Too often, the system is blocked by bureaucracy that prevents it from operating effectively at the point of use.
	Like other hon. Members, no doubt, I get a constant stream of letters on this issue from constituents, and this morning I received a letter from a constituent about his son:
	“I have a son…who has psoriasis and he has had this for up to a year now. He has been putting up with it, but it has come to the stage now that it’s unbearable. It’s all over his body including his private parts too. He had to finish work due to that. He can’t sit down with it…He is not sleeping at night. He is bleeding all the time. He can’t go out. He is always in his bedroom…he is in pain day and night.”
	My constituent’s GP referred him as an urgent patient to a local hospital, and he has an appointment for 28 March. He is going through hell, and he will go through two more months of hell before he is seen, let alone treated.
	Again and again we get such cases. There was a recent debate and meeting about blood diseases. I have a constituent who has a blood disease. He has HIV and is making no progress at all. It is heartbreaking to read such letters, but it is far more heartbreaking to live through such a situation than it is to read about it or even try to help.
	The situation is not only affecting the patients, or in some cases would-be patients. Without the essential contribution of NHS workers the service could not function, but they are being victimised. This year, 60% of NHS workers will get no cost of living pay increase at all. They have had a two-year pay freeze, followed by a 1% pay rise. National health service workers’ pay has fallen by 12% to 15% in real terms since this Government came to office.
	As a result of the shortage of funds available to the national health service, very bizarre things happen. I want to draw the Minister’s attention to something that is happening in my constituency and ask him to look into it. I have no great confidence that I will get any response, because at recent Health questions I raised two cases and was told by the Minister that they would be looked into. That was the last I heard from the Department of Health on the subject.
	I describe this situation because it is not only a major health issue, but a major community issue. Currently, there is no landing site available in Manchester for
	helicopter ambulances for either the Royal Manchester adult major trauma centre or the Manchester children’s hospital paediatric major trauma centre. There is a lack of money to provide a landing ground for air ambulance centres to do their vital work—heaven knows I praise them for it—so there is a plan to have a landing site in a park in my constituency.
	Friends of Birchfields Park, the organisation of local residents that looks after the park, had a meeting on Saturday. I promised them that I would raise it in the debate. There will be a landing site in the park, but it is a small park and part of it will be lost. It will be used something like every three days, so there will be disruption the whole time. Apart from the disruption in the park, the site is next to two schools, one of which is extremely near to the proposed landing area. It is a heavily populated area. A ground ambulance must go the site to pick up the patients who are landed, which will affect traffic on an extremely busy road.
	One of the most odd things of all is the effect on the park’s nature. Those responsible for suggesting that landing site say:
	“The majority of wildlife will evacuate the area proximate to the aircraft due to the noise and displacement of air and downwash during landing and take-off.”
	Apart from the affect on the wild creatures, which share this planet with us and ought to have as many rights as we have, the thousands of people who live in the area will be affected. I am not in any way belittling the air ambulance service—it is vital, essential and dedicated—but it is extraordinary that it will be reduced to using Birchfields park as a landing site because it does not have the money to create its own.
	All hon. Members pay tribute to the national health service. As I have said, heaven knows I have a greater duty than most in the House to thank the NHS for what it has done. Everybody needs it. It is just about the only service in this country apart from education that absolutely everybody needs. It ought to be given priority, but it has been severely damaged by the Government. That is accepted by the electorate. Every opinion survey shows that the Government are blamed for what is happening to the NHS, and that the electorate are worried about it. Roll on 7 May.

Simon Burns: It is a pleasure to follow the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), although he would not expect me to agree with everything he has just said.
	I listened to the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) with considerable interest. One thing that struck a chord with me was when, at the beginning of his speech, he said, basically, that the NHS should not be a political football. I could not agree more. It does a great disservice to the people who work so hard—the doctors, nurses and ancillary staff—to provide health care for the citizens of this country, to see it turned into a party political football. Let me explain what I mean by a political football.
	The Opposition have, of course, a democratic right to hold the Government of the day to account for their stewardship of the health service, as they do on education
	or anything else. Of course, every individual Member of Parliament, regardless of party, has a right to fight for the interests of their constituents with regard to health care if they feel that it is failing their constituents.

Ian Austin: Will the right hon. Gentleman give way?

Simon Burns: No, I will not, because I only have eight minutes.
	What I decry, however, is when, in the generality, the health service is used to attack a political party, whether the Government or whatever, simply to try to score cheap party political points. That does a grave disservice to the NHS. As the right hon. Member for Manchester, Gorton said, people in this country love the health service. They believe in it, free at the point of use for all those who are eligible to use it. I, like I imagine millions and millions of taxpayers, have no objection to paying our taxes to have a free health service. To appropriate the four freedoms of Franklin Roosevelt, there is a fifth freedom: the freedom from fear of a medical bill dropping on one’s mat and financially ruining one’s family.
	Where I see the greatest and, to my mind, the most disgraceful attack is in the accusation, which is not new—it was being made in 1979, and, I suspect, before then, but fortunately I am a bit too young to remember exactly—that the Conservative party wants to privatise the health service. We do not and we never have done. As long as I am a politician, and my right hon. Friend the Prime Minister is, we never will. I find it extremely aggravating and hurtful when this cheap shot is made.
	One of the examples of privatisation given is the use of the private sector to improve and enhance the health care of our constituents. Let me just explain something. Over Christmas, I read an extremely good new book, which I strongly recommend to the right hon. Member for Leigh (Andy Burnham), if he has not already come across it. “Nye”, by Nicklaus Thomas-Symonds, is the new biography of Nye Bevan. It is a fascinating book, particularly the part about when he was the Minister for Health from 1945 to July 1948 and putting together and negotiating the creation of the NHS. It sets out the arguments he had with the medical profession and others, and the compromises he had to make to establish the NHS. Many people do not realise that even to this day, as a result of those compromises, 95% of GP practices are private small businesses. I do not decry that, because they are treating patients, under the national health service, free of charge.
	Historically, a lot of mental health care has been free of charge, but provided by the private sector. In the 1990s, when I was a Health Minister, I remember John Major using the private sector to bring down waiting lists and waiting times for operations. My constituents had no problem whatever with that, providing it was free and kept to the core principle of the NHS. The last Labour Government, the Blair-Brown Government, were quite happy to use the private sector providing it was benefiting NHS patients.
	The shadow Secretary of State kindly mentioned—albeit in passing—Chelmsford walk-in centre and suggested it was a great political scandal and the next bandwagon he was going to jump on. May I point something out to him? The walk-in centre was created from the dying embers of his stewardship of the NHS, in March 2010, to be run by a private company. I have no problem with
	that, if it is serving NHS patients. However, its sole purpose was to reduce pressures on A and E at the local hospital, and I am afraid it has singularly failed to do that. The use of A and E at Broomfield hospital, just down the road, has increased inexorably and, in that respect, the walk-in centre has failed.

Andy Burnham: I am listening carefully to the right hon. Gentleman. As he knows, I have huge respect and affection for him, but he is arguing that NHS privatisation is a myth and that our accusation is wrong. If he does not mind, I will quote what he said during the Committee stage of the Health and Social Care Act 2012:
	“As NHS providers develop and begin to compete actively with other NHS providers and with private and voluntary providers, UK and EU competition laws will increasingly become applicable.”—[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]
	Why, then, is it a myth that he and his Government have exposed the NHS to a greater risk of commercialisation, marketisation and, indeed, privatisation?

Simon Burns: First, competition was introduced on the current scale by the Blair-Brown Government, and secondly, there is nothing wrong, per se, with competition to get the best providers providing the best care for patients, so long as they keep to the sole ethos of the NHS, which is that that good care be provided free at the point of use for NHS patients. We saw that under his Government and under the Major Government, and this Government have used the private sector to ensure that patients are treated more quickly. We want them to be treated as quickly as possible, and if there is not enough capacity in the NHS, and if a private provider can provide the capacity, I see nothing wrong with that, and neither do most people in this country, if they are treated more quickly.
	Returning to the walk-in centre, there were 40,000 attendances last year, 10,000 of which were by people beyond the Mid Essex CCG area. Of the remaining attendances, one third should have been self-caring or using their community pharmacy or 111, which the CCG is paying for, and another third should have been using their community pharmacy or GP, which the NHS is paying for. The CCG was therefore paying twice for the same care for the same patients, which is an utter waste of money. That money should be being used to care for more patients quicker, which is why the CCG has taken the decision it has. It is a rational decision, because the centre is failing to meet the aims it was set up for and instead ensuring that the NHS pays twice for the same patient to be treated. In place of the walk-in centre, there will now be an urgent care service at the local hospital for those people who should be going there. Some times, politicians have to do the right thing, regardless of political point scoring. Where it is in the interest of patients and the configuration of services, they should take the right decision, be reasonable and responsible and explain why it is the case.
	In conclusion, I am delighted to see the hon. Member for Hackney North and Stoke Newington (Ms Abbott) in her place. I am fascinated to note that the nub of the motion is a call for an extra £2.5 billion for the NHS, which I am sure she strongly supports. What worries and concerns me—she may have a problem when it comes to voting at 7 o’clock tonight—is that the motion goes on to say that it is going to be
	“funded by measures including a tax on properties worth over £2 million”.
	Given the battle the hon. Lady had on the radio with a member—a right hon. Member— of her party from a southern Scottish constituency, I imagine that she is in turmoil, wondering how to justify that funding from that source.

Diane Abbott: I am in no turmoil whatever. I will be walking through the Lobby with pride behind my hon. Friends. We cannot know exactly how much a mansion tax, if levied, would raise towards the national health service. What we do know is that the British people who want to save the national health service from the depredations of Government Members have to vote Labour. We have to vote for my right hon. Friend the Member for Leigh (Andy Burnham) to become Secretary of State for Health—

Lindsay Hoyle: Order. We do not need a statement; we have got the message.

Simon Burns: In conclusion, it is sad that the hon. Lady has completely undermined the case and the costings of the right hon. Member for Leigh (Andy Burnham). I have no doubt that when she has swallowed her pride and gone through the Lobby today, she will battle as hard as she is renowned for battling and will hit the leader of her party over the head to try to get him to see common sense and abandon this ridiculous policy that she also thinks is ridiculous.

Several hon. Members: rose—

Lindsay Hoyle: Order. I have tried to work within the spirit of the previous announcement, but I think the time has come to introduce the eight-minute limit.

Mark Reckless: My party believes in an NHS free at the point of use and funded out of general taxation. I support much of what is in the motion today. I, too, would question what it states about outsourcing, as it is not quite clear whether outsourcing will be based on hypothecation in relation to how much the mansion tax raises or on how much the Conservatives happen to be spending. I believe we need to decide the right amount to spend on the NHS and then to commit to it, rather than simply say it should be £2.5 billion above however much the Tories spend—either cutting or increasing. We should make a decision about how much the NHS needs and then fund it properly. I support the principle of joining up adult social care with the NHS, and I thought that the shadow Secretary of State made a persuasive case for a single budget.

Ian Austin: What does the hon. Gentleman think it tells us about his leader’s instincts when he said:
	“I think we are going to have to move to an insurance-based system of health care.”?
	Moreover, what does he think it tells us about his deputy leader’s instincts when he said that he wanted to
	“congratulate the coalition government for bringing a whiff of privatisation into the…National Health Service…the very existence of the NHS stifles competition.”?
	Does that not prove that ordinary people who rely on the NHS cannot regard UKIP as being in any sense on their side?

Mark Reckless: It proves nothing of the sort. The hon. Gentleman faces a very strong challenge from UKIP in his constituency from the excellent Bill Etheridge MEP. The policy of our party—[Interruption.] No, let me answer the point. Our policy is determined by our party as a whole. We are committed to an NHS free at the point of use and funded properly out of general taxation. [Interruption.] May I continue? I personally come from a mother and father who met in the NHS; the NHS and supporting it is in my blood. I believe in the NHS as I have described it, and I would appreciate the courtesy of people accepting the sincerity of what I say on that.
	I am pleased to see the shadow Secretary of State still in his place as he has been throughout the debate, but when it comes to funding the social care budget, it is a moving target to determine what that budget is. We know the local government settlement for the year ahead, but not for beyond that. We do not know what either a Conservative-led or Labour-led Government might be able to, or choose to, spend on local government, or what proportion might be allocated to public health budgets. It thus strikes me as a significant risk to say, without greater clarity, “This is what the budget will be, plus the sum of £2.5 billion”—the figure selected by the shadow Health Secretary and his party, irrespective of what the baseline is.

Steve Rotheram: Can the hon. Gentleman be absolutely certain of what his party might or might not do should it ever—unfortunately—find itself propping up a Government? Can he assure us that the road to Damascus-style conversion that he is describing represents the view of the whole of his party, and not just his individual view?

Mark Reckless: Yes, I can give the hon. Gentleman that assurance. It is the view of my party, it is the view of the whole party, and it is my own personal view, which is core to my politics and what I came to the House to represent.
	The Prime Minister said earlier that I came to the House week after week to discuss the NHS in Kent. Following what could perhaps be described as an endorsement of my approach from the Prime Minister, I now wish to raise some of the issues that have arisen in Medway. One of the problems with the motion is that it makes no mention of introduction of the new GP contract in 2004, which I believe has been a significant driver of increased demand for A and E services.
	In Medway, where the proportion of single-handed general practices is significantly higher than the national average, the burden of out-of-hours care falls largely on an organisation called MedOCC. While I would encourage constituents to use MedOCC rather than A and E when that is appropriate, I have one or two concerns about the way in which it operates.
	Like the hon. Member for Wirral South (Alison McGovern), we had a young child who was ill, and we sought an appointment. My wife telephoned MedOCC
	and we were offered an appointment at a particular time, but were then told that the wait would be an hour and a half. We said “If the wait will be an hour and a half, why do you not give us an appointment an hour and a half later than the one that you have just given us?” However, that was not allowed. We had to wait for an hour and a half, because that was the procedure, and that was the way it had to be. Although we went to the MedOCC clinic because we thought that that was the appropriate service, I would understand it if a constituent in the same circumstances decided to take his or her chances at A and E, where it might even be possible to be seen more quickly.
	It is important for an out-of-hours service—in our case, MedOCC—to be flexible and responsive, and to be operated in a way that makes it an attractive and appropriate alternative to A and E, and I shall develop that point further when I meet members of the clinical commissioning group on Friday.

Rehman Chishti: The hon. Gentleman and I share the same hospital in Medway. Will he join me in welcoming the extra £13.4 million that has been given to its A and E department, the extra £6 million of winter funding, and the additional £10 million that has been given to the CCG to help to improve local health services?

Mark Reckless: I do indeed welcome those sums; I pressed for them strongly. I was particularly delighted by the provision of that £13.4 million for the rebuilding of the A and E department, which I think is essential. I am now campaigning for the provision of a further sum of approximately £20 million so that the hospital can build what it describes as an “emergency village”, consisting of short-stay medical wards around the A and E to improve the throughput of patients and the quality of care.
	I have also helped the hospital with its efforts to ensure that patients are referred more appropriately, and are not necessarily sent to A and E. If a GP refers a patient to hospital and that patient has a known condition, surely it is better for the patient to go to the relevant ward than to be pushed through A and E, which is not an appropriate environment for someone who has already been assessed by a GP. Similarly, A and E is rarely the right environment for people suffering from dementia. It is best for action to be taken at the nursing home or by GPs, possibly based alongside A and E, who can make a speedy assessment and transfer the person to an appropriate treatment area. I am also pleased by the decision to end the so-called Star system in Medway A and E. The idea was that someone would be assessed by a senior clinician before it was decided what should be done, but that was not happening within a sensible time scale. That system has now been replaced by nurse-led triage, which I think will work better.
	I am also grateful for the support we have received from other hospitals, notably the Homerton, which has an excellent A and E department. Medway has benefited from secondments there. It is important that those secondments and that support are integrated with the permanent staff in Medway hospital and the clinical director lead for emergency medicine is key.
	We have had extra consultants appointed in emergency medicine at Medway hospital, which I strongly welcome, but I must mention the terms and conditions of emergency
	doctors. It is an extraordinarily demanding specialty and doctors working in it rarely have the opportunity to take on private work, which is a consideration for some but not all doctors when they make their choice of specialty. To encourage more doctors to come in to this field, should we consider changes to the lockstep consultant contract so that doctors in the extraordinarily demanding area of emergency medicine can perhaps receive more pay than others who in specialties that are not as extraordinarily demanding, to which some might have been attracted by the potential for private earnings that they could not make in emergency medicine?
	The Secretary of State tells me that what is actually required is more holidays for A and E doctors. That might be the case, but it would require pulling more doctors in to emergency medicine to cover for colleagues on holiday. I question a system in which high numbers of agency staff are used for a day or a week. Hospitals with problems in A and E and that have problems attracting people can fill places with those staff by paying very high rates, but they do not necessarily gel as a team or provide support in anything but the short term. We need to make emergency medicine attractive for doctors.
	Finally, on the question of Monitor and the CQC, Medway hospital is a foundation trust. That happened in a largely box-ticking and financial exercise under the previous Government that ignored the death rate being one in 10 higher than it should have been, as mentioned by the hon. Member for Gillingham and Rainham (Rehman Chishti). Although Monitor has been reasonably sensible in its approach to Medway, it cannot come and run the hospital. We had to look to the board to do that. Similarly, the CQC has made some sensible interventions, for example on A and E, but in 2012 it said that Medway was a good hospital that was meeting all its standards. I believe that many of the problems we are seeing were in place then but were not identified by the CQC. My party wants to replace some of the alphabet soup of bureaucracies and regulators, such as Monitor and the CQC, with directly elected health boards that could, we believe, oversee these things better.

Paul Maynard: It is intriguing to follow the hon. Member for Rochester and Strood (Mark Reckless). I will leave my intrigue at that point and focus on the debate rather than him.
	It is a shame that the shadow Secretary of State has left the Chamber, as I was about to say something relatively pleasant and polite about him—he will not hear it now. When he came up to Lancaster and Fleetwood a few weeks ago he joined me in praising my local A and E department, which had seen 97% of patients within four hours, the fifth best performance in the country that week. That is a superb achievement given the complex health economy in Blackpool. It is very rare that we are at the top of a league table for the right reasons in Blackpool, whether that is for football or for health care, so I welcome that.
	It was interesting to note a more hidden and nuanced message in what the shadow Secretary of State had to say. The medical director of Blackpool Victoria says that between April and September 2014, 36% of those arriving at A and E did not need to be there. They could have received their diagnosis or treatment somewhere
	else, and the cost to the hospital was calculated at £842,000. The message I draw from that is that we still have an immense amount of work to do to ensure that people know where to go for the right treatment at the right time. It is, of course, incumbent on us to ensure that those alternatives are resourced, that people know where to go and that people have confidence in the alternatives.
	We have not spoken enough today about pharmacies. Pharmacy trade bodies and the industry put so much into lobbying Members on both sides of the House, but I think it will require another decade or so of intensive lobbying of MPs before we finally get the message that it is far better to have first recourse to the local pharmacist to see whether one needs to go further in seeking appropriate health care. I rely on regular repeat prescriptions for my epilepsy, and I have saved myself many a GP visit by asking a question at my local pharmacy. We are overlooking the most basic corner-of-our-street access point for primary health care, and we should not forget it.
	I want to praise another Member of a different political party from mine, and he is sitting on the Government Front Bench: the Minister of State has already been praised today for his approach to mental health care. It is warmly welcomed, particularly in a town such as Blackpool. Our new 74-bed harbour unit is about to open on the edge of the town. It has been long-awaited, and is much-needed following some of the appalling standards of care at the Parkwood unit over the past decade.
	The Minister will know that he faces great challenges. I could easily have come here today and read out a number of immensely tragic cases involving young people not getting the appropriate mental health care. He still faces a battle with the profession, because clinicians differ over their assessment of this issue. I see far too many young people with some learning disorder who are somewhere on the autistic spectrum, where the clinician refuses to accept that they can both have a learning disorder and a mental health problem. They fall into that gap and are batted backwards and forwards between different providers. There must be a battle in the medical profession over how to reconcile those two different forms of clinical diagnosis.
	Another point I want to raise—I have far more than I will be able to get into my remaining four minutes—was mentioned by my right hon. Friend the Member for Chelmsford (Mr Burns). I was struck by the shadow Secretary of State’s sudden enthusiasm for the walk-in centre in Jarrow—his instant commitment that it would be saved were Labour ever to come to power. We then heard from my right hon. Friend that these things are sometimes trickier than that—that there is more nuance, perhaps. We in this Chamber often think we know it all—don’t we? We think we know everything there is to know and that we can learn nothing from anybody else about anything in our constituency—that we are the sole experts of what is right. Occasionally it would be nice to listen to the clinicians. There might actually be a clinical argument for why a particular unit has to open, close or reconfigure, but all too often debates on the reconfiguration of services become a political football—which is exactly what my right hon. Friend was saying.
	A good example is stroke unit in Blackpool. It has been a controversial addition because it was designed to serve the entire north-west. Patients were coming down
	the M6 from south Cumbria, past four or five other hospitals, to get higher quality treatment in Blackpool. As the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) chuntered during the Secretary of State’s speech, the important point is that it was about outcomes. People were going to have a better chance of survival if they went to the stroke unit in Blackpool rather than their local A and E. Yet when that was debated, it was very hard to tease out the medical arguments in favour of this innovation, because all too often we were more concerned about focusing on saving bricks and mortar in our own backyards rather than on what is actually best.

Steven Baker: Does my hon. Friend agree that the two brands in the NHS that the public really understand above all are A and E and GPs, and all the time we are talking about A and E we are getting away from the fact that sometimes care is better provided in a specialist stroke or heart centre?

Paul Maynard: My hon. Friend makes an important point, which is that so many different terms are used and answers given in this Chamber and elsewhere about where patients need to go. What they actually want is reassurance and confidence that when they go somewhere they will get the right treatment at the right time that solves their problem. They do not want it to be overcomplicated, and neither do we.
	We have heard a lot of criticisms of this Government’s health reforms—they seem to be very unpopular on the Opposition Benches in particular—but let me highlight two that have been very good. One of them goes back to my younger days—when I had a finer figure, perhaps. My first proper job—Opposition Members will not like this—was as a health policy officer in the Conservative research department in 1999, so I listened with delight to the right hon. Member for Holborn and St Pancras (Frank Dobson) telling me all about the wonders of his time, because I scrutinised it quite carefully on a daily basis. I used to get a monthly present from the Association of Community Health Councils for England and Wales in the form of the London “Casualty Watch”, a monthly census of trolley waits in London accident and emergency departments. It was a pretty thick document. The census detailed page after page of trolley waits of more than 24 hours, and it was a shocking indictment of how Labour was running the NHS at that time.
	That situation led to one of the Labour Government’s most shameful decisions: to abolish community health councils. I know that many Labour Members are embarrassed about that even now. One of the great things about our health reforms is that we have brought back Healthwatch, which has proved to be a thorn in the side of local health providers, of Members of Parliament and of the Government. We have brought back the ability of ordinary patients to affect the nature of the care in their communities. That is happening right now in Blackpool, and it is making a difference. I am delighted about that.
	Another positive element involves putting public health matters into the local council. As I have said, Blackpool faces immense public health challenges, but putting Dr Rajpura, our local director of public health, into the
	council has been a tremendous success. It has helped to pull together all the disparate strands within the town as we face those challenges. Again, this has happened only as a result of our health reforms.
	Another example that I want briefly to mention is the fact that some of our local nurses at the hospital have spun out their rehabilitation service into a community interest company called Spiral, which is now winning awards for the quality of its patient care. I am concerned that, if Labour were to reverse all these changes, the good things we have achieved would be washed away and lost, and the people who would suffer would be my constituents, including those who have turned to Spiral for their rehabilitation. That is my real concern.

John Woodcock: I want to talk about the situation in hospitals across the Morecambe bay area, and I shall start with the inquiry into neonatal deaths at Furness general hospital. The inquiry is led by Dr Bill Kirkup, who distinguished himself as a member of the independent Hillsborough inquiry panel. It has now heard from more than 100 witnesses, of whom I was the first, over a period of nine months. That has involved regular long trips from Barrow to Preston for the grieving families, who have had to relive those deeply traumatic periods in their lives in great and painful detail.
	There has been a lot of talk about politics today, and about its relationship with the national health service. I do not think we should deny the real differences between our parties; we should be prepared to debate them and to put the choice before the British people at the election. That will involve disagreement, argument and debate. However, it pains me to hear the Secretary of State accuse me and other Opposition Members of being selective in the way in which we talk about the problems in the NHS. I have to say to him that I do not care if the Morecambe bay inquiry turns out to be politically difficult for any side. As the Minister of State, the right hon. Member for North Norfolk (Norman Lamb), knows, I helped to secure the inquiry on behalf of the grieving families, who, with great persistence and determination, persuaded me of the need for an independent examination to run alongside the criminal inquiry, rather than taking place subsequently. I am determined to get to the truth, and I am determined that lessons should be learned, no matter how painful they might be for anyone.
	The Secretary of State is no longer in his place, but if he wants to stamp out shabby political point scoring I advise him to have a word with his colleague, the hon. Member for Morecambe and Lunesdale (David Morris). It is a shame that the hon. Gentleman has not attended this debate to stick up for his own local A and E, which I know is facing real pressures. The last time the inquiry was in the news, the hon. Gentleman used those neonatal deaths—which did not relate to his constituency or to the hospital there—to call for the resignation of the shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham). I am sorry to speak so frankly, but if someone is prepared to use the deaths of babies for this kind of political stunt because someone in Tory central office suggests it or just because they themselves think it is a good idea, there is not much they will not do. So just as the families, who have gone through so much in their grief, will not forgive
	anyone who does not face up to the full gravity of the findings that are coming, so I will not forgive anyone who uses this inquiry for political sport.
	For all the problems, and I understand that the inquiry may well make difficult reading, we in Morecambe bay and at Furness general hospital are not the next Mid Staffs. There will be no excuse for anyone who allows the destabilisation and turmoil that the region has suffered to be recreated in Morecambe bay just because it fits the narrative composed by Lynton Crosby or some election agent in Downing street. I hope I will get some assurance from the Minister on that point in his winding-up speech. It is also important that this inquiry, which I understand is to report in the middle of next month, is dealt with fully but is not allowed to divert focus from the real problems the trust is enduring now and the need for a proper funding solution to put our hospitals on a more sustainable footing.
	Let me briefly address the pressures currently being felt in Morecambe bay. Ambulances have been mentioned, and the hon. Member for Blackpool North and Cleveleys (Paul Maynard), whom I have the pleasure of following, spoke of his local hospital in Blackpool. Patients in south Cumbria will often travel by ambulance to Blackpool. Sometimes that is a good thing, because of the real expertise available, but too often recently ambulances have been diverted from where they are needed in south Cumbria to serve the Blackpool area because of shortages there. On 5 and 6 January, two ambulances, one serving Ulverston in my constituency and the other Millom in the constituency of my hon. Friend the Member for Copeland (Mr Reed), had to come to Fylde and the Blackpool area. Obviously, once they were there they were required to serve other patients needing help in the Fylde and Blackpool area, leaving the service in south Cumbria severely stretched—and all this when the beginning of January had seen a 25% year-on-year increase in ambulance call-outs across the north-west. We urgently need from the Government not only action to relieve the pressure on accident and emergency departments, but a recognition that areas such as Furness, which are out on a limb, can end up in a difficult situation because of ambulances being redirected around the country.
	There have been real pressures on A and E in my constituency, as there have been across the country. Two weeks ago, when this issue last flared up in the Commons, the University Hospitals of Morecambe Bay NHS Foundation Trust was cancelling all non-urgent operations so as to be able to deal with the crisis in A and E. I have spoken to people in the trust today and they say that the situation has eased a little in recent days but remains fragile. All these problems must be addressed, but I have repeatedly pressed the Government on this. I was so grateful to the shadow Secretary of State, on his recent visit to Morecambe, for the assurances he gave on recognising the unique geographical situation of Morecambe bay and the funding priority it would get under a future Labour Government. Our population of 300,000 is spread out across the Morecambe bay area and the transport links are difficult. If things are to be easier, our area ought to be more compact and served by one big general hospital, and it cannot survive with the three hospitals it has unless very severe cuts in services are made. We are still waiting for an answer from the Government on whether they will recognise that case and provide us with the long-term extra funding that our area needs.

Steven Baker: I begin by paying tribute to the staff and leadership of Buckinghamshire Healthcare NHS Trust. The trust went through special measures as a result of the Keogh review, when it was found to have high mortality, and they have done a sterling job of turning the trust around. On my visit recently with my right hon. Friend the Secretary of State for Health, I found a renewed enthusiasm and optimism in the trust, and I am very grateful to the staff and leadership for delivering that outcome.
	When the right hon. Member for Leigh (Andy Burnham) opened the debate, he asked for shared solutions, striking a markedly different tone from the usual partisan pose. I shall suggest some shared solutions later in my speech. But normal service quickly resumed. The right hon. Gentleman spoke of stories of failure. There are, of course, some stories of success, and I shall mention a few. England’s NHS has the best measured emergency care performance of any western nation, according to NHS England. Dr Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, said:
	“In the week ending December 28th A&E attendances were up more than 31,000 on the same period last year, meaning we successfully treated more patients in under four hours than ever before.”
	I will come to why in a moment.
	The Government have allocated an additional £700 million to cope with winter pressures. The College of Emergency Medicine said:
	“This represents the largest annual additional funding yet seen.”
	In the course of this Parliament, the NHS budget will have increased by £12.7 billion in cash terms. This additional winter pressures funding has paid for 2,500 additional beds in acute and community treatment and the equivalent of 1,000 doctors. There are almost 1,200 additional A and E doctors, including an additional 400 A and E consultants and 1,700 additional paramedics since 2010. Some 850,000 more operations are being delivered by the NHS each year compared with 2010, and numbers waiting longer than 18, 26 and 52 weeks to start treatment are lower than they were under the previous Government. It cannot reasonably be said that that is a continuous record of failure. There are considerable successes under this Government.
	In an intervention on my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), I mentioned branding. One of the things that we could do is continue to tell patients that they should go where treatment can best be provided, but we see that patients stubbornly insist on going to hospital. The brand A and E is well understood; people know that if they have an urgent problem, they can go to A and E. It will take years of persuasion before people behave differently, and I do not think we should keep on persuading people to want something other than the preference they are clearly displaying by their behaviour, which I shall return to.
	Let us not forget the legacy that the Government have had to cope with, including the grievous financial position that they inherited. Let us not forget that around the world special monetary measures are still in place to ensure that Governments can keep spending. We have had problems with patient care. I alluded
	earlier to the turnaround in Buckinghamshire; across the country, there have been special measures and turn- arounds. The BBC reported that a probe into whistleblowing has been swamped by people getting in touch. The Government have had to deal with an enormous range of cultural problems and turnarounds.
	That brings me to solutions—first, funding. In Buckinghamshire there are pockets of real poverty. In my constituency in Micklefield, Castlefield, Oakridge, Bowerdean and Disraeli there are—by anyone’s standards —pockets of poverty and deprivation, but we suffer on funding because of how it has historically been calculated. It is time for us to look seriously at where the demands on A and E are coming from, and to reorientate funding towards the human factors producing that demand—that is, ageing. Where there are older populations, they should be properly funded. It is a simple matter of treating people humanely, decently and—dare I say it—equally.
	Secondly, it is time for us to take seriously the documents of NHS England. I am talking about not just the urgent care review, which I have in my hand, but the “Five Year Forward View”. What we see emerging now is a clear vision of where places such as Wycombe should go. It is becoming increasingly obvious to me that we will never manage to achieve the return of an old-style A and E to Wycombe hospital. The clear reason for that, as set out by NHS England, is that the NHS is moving in a different direction. The urgent care review includes a clear model of future urgent care, with major emergency centres, emergency centres and urgent care centres.
	I am not able to tell the hospital trust and the clinical commissioners what they should do, but if I could I would now have a clear understanding from NHS England’s own documents of what should be done in Wycombe. We have a very expensive public finance initiative hospital, and we need to make the most of it for the 20 years-plus that are left to run on it. We should have an urgent care centre, an enhancement of the current minor injuries unit, a pharmacy, GPs, social services, nurse practitioners, and a full set of services and diagnostics in Wycombe named in a way that the public can understand. We should be proud of the centre and encourage people in Wycombe to present there if it is the best thing for them to do. We should not turn off the 111 service, and we should provide the services that people need in the places where they present.
	We cannot go on for ever pretending that we will re-educate the public to want something different; that is not going to happen. I am not suggesting that we have an enormous new surge in admissions—nobody wants that. What we should recognise is that the vast majority of people, when they are in difficulty, want quick reassurance. If the people of Wycombe were in charge, they would want our hospital to have a full range of diagnostic and treatment facilities available to them all year round, giving them peace of mind. They would not want poor quality care. I think most people would accept being stabilised and moved to the place that could give them the best care.
	We have a heart attack and stroke unit. I do not suppose that many people in Aylesbury, where there is an A and E unit, would be very happy if they realised that in the event of a heart attack or stroke, they would
	be coming to Wycombe. But that is the point. A huge amount of confusion, waste and anxiety is being wholly unnecessarily created despite the fact that NHS England, through the forward view document and the review of urgent care, has set out a clear trajectory on how to give the public peace of mind and the right treatment in the right place—yes, close to home, but also making best use of the PFI hospitals, which are a millstone around the NHS’s neck. We should do the absolute best we can to get best value for money, which means a new generation of urgent care centres in places such as Wycombe.

Angela Smith: I feel privileged to take part in this important debate, which has focused on how the state of the NHS is playing out in Members’ local areas. The contribution of my right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman) encouraged me to reflect on just how recently the NHS was formed. It was launched by Nye Bevan on 5 July 1948, which means that anybody alive today who is in their late 60s or older would have been born before the NHS was created.
	My parents, for instance, were war babies, born well before the NHS was launched. That reflection serves as a reminder not just of how recent the NHS is, but of how easy it might be to let the NHS slip away from our grasp. It is not something that we can take for granted. It is the responsibility of all of us in this place who truly believe in the NHS not only to fight for its survival—that is not good enough—but to see it strengthened and always fit for the challenges of our time. Currently, those challenges are many.
	In an intervention earlier, I referred to the sickness and absence levels beginning to emerge across the country, including in Barnsley, in my constituency, and in Sheffield, and how much that is costing the NHS, but also how much it reflects the problems that the NHS faces.
	I want to focus briefly on ambulance services, because they have not featured very much in today’s debate yet they are a pressing issue in my constituency. I represent an outlying area of South Yorkshire, which extends well into the national park. It is predominantly rural and is suffering from serious problems. I will use two cases to demonstrate the problems that we are facing.
	Mr Offord collapsed on 16 April 2013, at approximately 11 pm. A 999 call was made, but a double-staffed ambulance did not get to Mr Offord until 11.25, by which time he was in respiratory arrest. On being transferred to the floor from the sofa, he was determined to be in cardiac arrest. He died the following day. The coroner ruled that there was a serious lost opportunity in the failure to consider alternative sources of support for a lone paramedic—the first response to the call—and that Mr Offord would probably have survived if he had received medical attention earlier. Mr Offord’s family, obviously very distressed, have settled that case out of court, but they want a wider justice for their son and brother. They want to see ambulance services and response times improved.
	Mr Bailey, who I mentioned in my parliamentary question earlier today, collapsed in a shop. As I said, it took an hour and four minutes—and it was a Red 2 priority call—for an ambulance to get to him, despite the fact that the symptoms described in the emergency
	call were apparently those of a stroke; indeed, he had suffered a major stroke. This detail is horrific, but I must place it on the record: he had to have part of his skull removed because of the severity of the stroke. In summary, the dispatcher made two errors, which contributed to the delay in an ambulance attending to Mr Bailey, and—these are the words of the Yorkshire ambulance trust itself—“no checks” were
	“made for an available ambulance from 13:31 until 14:03; and no allocation”
	was made
	“of one of the nearer ambulances identified at 14:11.”
	All the ambulance trust has to say is:
	“Please pass on my sincere apologies to both Mr and Mrs Bailey for the errors and the delay caused.”

Sharon Hodgson: I am so pleased that my hon. Friend has raised this important issue. I have had so many people write to me about the state of the ambulance service. One gentleman, over a year ago, had to wait for two hours. I have also been contacted by a whistleblower from the call centre who is discouraged from sending ambulances—they have to dig and try and find any way. Does my hon. Friend agree that this is desperate and needs to be sorted out?

Angela Smith: I thank my hon. Friend for that intervention and I am really sorry to hear of the cases she raises. The situation really does need to be sorted out, because the Yorkshire ambulance trust goes on to say that
	“the service was experiencing a high level of demand in the South Yorkshire area around the time of Mr Bailey’s incident. Overall, demand was 12% above predicted levels and the level of ‘Red’ call demand was 55% above predicted levels…Rising demand on all health care resources continues which requires changes to deliver improvements in urgent and emergency care.”
	I shall say no more about Mr Bailey’s case because it will be referred elsewhere and it may well go to law—I have simply set out the facts of the case as they have been put to me—but the point is this: why are we experiencing these problems with response times in the ambulance service? Why are we hearing, week after week in Prime Minister’s questions and on the Floor of the House in other debates, that the ambulance service is letting people down—even in the most serious cases, when people are going into cardiac arrest or having a major stroke?
	We need to establish the reasons, and I suggest that there are three obvious ones. There may be more—there may be problems with the management of ambulance services, and in many cases there clearly is a problem in the case of YAS—but I would suggest that there are three obvious problems. One problem is the increasing difficulty that people have in getting access to GPs’ surgeries. The evidence was laid before the people present for this debate earlier, by the shadow Secretary of State, so I will not go through it again.
	Secondly, there has been the closure of NHS Direct and the establishment of NHS 111. There is no way that NHS 111 can be compared with NHS Direct; it is like comparing apples and pears. I have used NHS Direct in the past. It was a superb service that enabled me to decide which was the appropriate place to go to for my treatment and to get the right treatment at the right
	time. I can assure hon. Members that the one place I did not end up, having used NHS Direct, was A and E—that would have been the last place I had to go to.
	Thirdly, social care cuts represent one of the most fundamental problems of our time. As my right hon. Friend the Member for Wentworth and Dearne (John Healey) said, £1 in every £10 has already been cut from social care budgets. It is obvious, even to the most disinterested observers of the debate on health, that cutting social care budgets at local authority level will ultimately impact on the health service. I was in local government for 10 years, and I saw for myself the importance of the local authority and the local NHS working together to enable elderly people to stay in their own homes and to keep them out of the health system—the acute health system, in particular—as much as possible.
	The shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), outlined what needs to be done in the very long term, strategically, to get the NHS in the right shape. He also outlined the more immediate actions that a Labour Government would have to take if they gained power in May: providing more clinically trained staff to handle NHS 111 calls; restoring the GP guarantee of an appointment within 48 hours; and ensuring that councils, the NHS and the local voluntary sector work together to identify older people at the highest risk of hospital admission and link them up with the right support. I cannot wait for 8 May to see that strategy for the short term being put in place.
	Ambulance services are crucial to the trust that people have, and need to have, in their local health services. One can broadly measure the trust that people have in their local health service by how much they can rely on their ambulances. Everybody likes to think that if they need an ambulance they will get one, and get it quickly. I was disappointed this afternoon that the Prime Minister used my question to indulge in petty political point-scoring. These issues are too serious for that. He did not even express sympathy for the family affected and instead made a cheap point about NHS staff. That was disgraceful. It is not good enough, and it is not good enough—

Lindsay Hoyle: Order.

Jeremy Lefroy: It is a pleasure to follow such thoughtful speeches, in general, on this subject. I thank all the staff at the accident and emergency departments that serve my constituents, whether at County hospital in Stafford, Royal Stoke University hospital, New Cross hospital in Wolverhampton, or Manor hospital in Walsall.
	On many occasions in the House over the past few years, the tragic events in my constituency have been referred to. Whenever they are referred to from now on, I would like people to acknowledge the enormous progress to improve health services that has been made in Stafford at what is now County hospital and throughout my constituency. It is absolutely vital that we remember what is happening now as well as where we have come from. Let us not forget that out of the Francis report has come the tremendous emphasis on patient safety and compassionate care that is vital for all our constituents. I do not want Mid Staffs to be used just as shorthand
	for something that was clearly very poor care; it should also be shorthand for the huge improvements that have been made by the people working there and the NHS staff in many other hospitals throughout the country.
	I would like to look in a bit more detail at what this motion proposes and the reasons we are currently suffering from the huge demand on accident and emergency services, particularly in relation to out-of-hours GP services and delayed discharges. Regarding the pressures on A and Es, it has rightly been said that there are 600,000 more attendances every year, but we are finding that there are 4,000 more admissions every week—some 200,000 a year. That indicates the seriousness of the situation, because people are not admitted to hospital unless they are in a fairly serious state or seriously unwell. It shows that we are now entering a phase in which the baby boomer generation needs more acute care. We welcome the fact that people now live a lot longer, but the fact is that when people get ill in later life, they tend to be acutely ill and to have complex needs, and that results in their admission to hospital.
	The right hon. Member for Holborn and St Pancras (Frank Dobson) mentioned the ratio of beds to population in the UK. We have one of the lowest ratios in Europe—we have a very efficient health service—but the idea that we can get an even lower figure is pie in the sky. In fact, we ought to go marginally in the opposite direction. We should certainly consider increasing the number of beds. Let us not forget that our patient stays in hospital are shorter than most comparable figures across Europe.
	We need to bear in mind that we will get more and more admissions, and we need to have the capacity for that. As I remember only too well, I argued a few years ago that the design for the new hospital in Stoke-on-Trent would make it too small; indeed, it is too small, and we are now increasing the number of beds there.
	The King’s Fund has said that only 55.4% of patients say that they know whom to contact for out-of-hours services, and such a lack of information or lack of clarity has already been mentioned. We need something straightforward and simple, and frankly, it must be available 24/7, because emergencies happen 24/7. That is why I have pushed for my A and E to reintroduce 24/7 care, rather than its current 14/7 care. People have to look at the clock to check whether it is nearly 10 pm, and then ask themselves whether the A and E will still be open or whether they will need to go elsewhere. They avoid going to another hospital because our A and E is so good, so they delay going until 8 am, by which time they may be in a worse condition. If the facility is for emergencies, it needs to be open 24/7. I welcome the fact that we will soon get an overnight doctor service shortly. A and E needs to return to 24/7 not only in my case, but in other centres that do not offer a full-time service.

Steven Baker: Does my hon. Friend agree that putting GPs into such centres provides the possibility not only of having integrated care, but of treating most people who present overnight, when an A and E consultant might not be available?

Jeremy Lefroy: I entirely agree, which is why I welcome the introduction of an overnight doctor-led service at the County hospital in Stafford, even though I would
	like such services to go further. A parent whose child is sick with a temperature may not want to be a burden on the ambulance service by calling one out but will still want to be seen at that time, rather than having to wait until morning, so being able to go to such a service gives them reassurance. If the child is particularly unwell, they can then be referred to a specialist centre, but otherwise the parent can be reassured that they can wait until the morning. Such matters are vital for our constituents.
	It is, indeed, a problem to get GP appointments, and it is vital that the issue is sorted out. There are wide discrepancies. In the practice I attend, I can get an appointment the next day not just because they want the local MP to be seen, but because they are very well organised and their patient load is not huge. That is simply not the case in other practices, and some people in my constituency have to wait two or three weeks for an appointment. The problem must be sorted out, and there must be evenness across the country.
	GP surgeries put an additional pressure on A and Es. The statistics show that the patients of some GP surgeries attend A and E far less often than those of other surgeries, because such GPs take the time to have longer appointments and take the trouble to go through problems and deal with them on the spot, whereas others are more inclined to say, “I haven’t got the time, so you had better go to A and E.” The statistics show that for some GP surgeries the ratio of patients attending A and E is almost twice that of others in the same area and with the same demographic.
	Delayed discharges have often been referred to in this debate. The figure was relatively stable until the start of 2014-15, but since then the total number of delays has risen by 19%. The King’s Fund analysis suggests that delays attributable to NHS services have risen from 60% to 68%, whereas those attributable to social care have fallen from 35% to 26%. It states:
	“This suggests that capacity and workforce issues, particularly in nursing homes and non-acute services”
	—within the NHS—
	“are becoming more important than social care funding”.
	I find that very interesting. I do not know on what evidence it is based, but the King’s Fund is a respected institution and we must look at what it says. It implies that there is an issue with integration not just between the NHS and social care, but between acute NHS services and non-acute NHS services.
	So what should we do? First, we have to recognise that there will be increasing demand for complex acute care and, hence, for accident and emergency services. A and E departments therefore need to remain open and to expand. I welcome the fact that the A and E in Stafford will double under the investment plans. Secondly, we need clear pathways for out-of-hours care, rather than complicated pathways that are difficult to understand. Thirdly, we need clear information relating to those pathways. Fourthly, we need to do much more work on access to GPs and must look much more closely at the results of GPs in avoiding A and E admissions among their patients. Finally, we need to make integration a reality, not just between health and social care, but within all NHS services and social care.

Ian Austin: It is always a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy).
	I ask Ministers to look at the situation at Russells Hall hospital in my constituency. Like anyone who lives in Dudley, I queue up at Russells Hall when I am ill. I know how hard the doctors, nurses, midwives and all the other staff at the hospital work. Over Christmas, they battled heroically to tackle unprecedented demand in A and E. The chief executive herself pushed trolleys around as they fought off the crisis that has been seen in hospitals elsewhere. I place on the record my appreciation for all their hard work over these difficult weeks.
	Last week, we had the shocking news that 400 of Russells Hall’s 4,200 staff—that is one in 10—will have to go, including 200 over the next couple of months. In common with other NHS trusts, the Dudley Group NHS Foundation Trust is required to make efficiency savings of 4% a year, which equates to £12 million each year. At the same time, the hospital is facing cost pressures that are caused by increasing demands on emergency services and the need to provide seven-day services. As a result, the hospital is predicted to face a deficit of more than £7 million by the end of March. I want Ministers to see what they can do to address that issue.
	As a first step, the hospital is looking to make voluntary redundancies. Depending on how that goes, it might have to make compulsory redundancies. Like at any hospital, managers at Russells Hall have to ensure that every penny is spent wisely and that every possible efficiency is made before they cut staff and front-line services. People in Dudley agree with me: two-thirds of the hundreds of local people who responded to my survey this week think that front-line staff must be the priority. Community GP practices were their second priority.
	Everyone agrees that savings should first be sought among management and back-office functions. However, even if every manager at Russells Hall was sacked—obviously, that cannot be done—it would not come close to the savings that the hospital needs to make. Instead, the redundancies that the hospital is making might include theatre staff, radiologists and staff who deal with things such as blood tests. Even some midwives will be able to apply for redundancy. The trust says that it will do everything it can to protect the service that patients receive, but no one can pretend that our hospital can lose almost one in 10 of its work force without it having an impact on front-line patient care. We just need to look at the pressures that they have faced over the past few weeks. How will they deal with a situation like that after losing so many staff?
	Local people share my concerns. I asked thousands of them about this issue this week and 98% said that they thought care would get worse if the job cuts went ahead and eight out of 10 said that they were already noticing longer waits for treatment locally.
	I have raised this issue in the House with Ministers before. I warned them last year that more resources were needed to deal with waiting times and with the deficit. I ask Ministers to look at this situation and to ensure that our hospital has the resources it needs to serve my constituents and not lose those members of staff.
	My second point contrasts the current Government’s record with that of the previous Labour Government. The previous Government built a brand new £300 million hospital in Dudley, with more doctors and nurses treating
	more patients more quickly than ever before. Despite promising no top-down reorganisation, this Government squandered billions that should have been spent on front-line patient care—£20 million in Dudley alone—on a bureaucratic shake up. As a result, local people are facing longer waits at A and E, cancelled operations are at their highest level for decades and waits for vital tests and treatments are increasing. We need a Government who put patients in Dudley first. That is why I welcome our plans to tax homes worth more than £2 million to pay for 20,000 more nurses, 8,000 more GPs, 5,000 more home care workers who have time to look after the elderly and vulnerable people they care for, and 3,000 more midwives.
	My third point—it is a shame the hon. Member for Rochester and Strood (Mark Reckless) has left the Chamber—contrasts our proposals with what UKIP has said about our NHS. Nigel Farage said:
	“I think we are going to have to move to an insurance-based system of healthcare.”
	His deputy, Paul Nuttall, said that he wanted to
	“congratulate the coalition government for bringing a whiff of privatisation into the beleaguered National Health Service”
	and that the
	“very existence of the NHS stifles competition”.
	That is what senior people in UKIP believe.
	Just this week, Nigel Farage suggested that the NHS might have to be replaced by a system of private health insurance within 10 years and that his party will return to that idea after the general election in May. When I challenged the hon. Member for Rochester and Strood about that, he said that his parents met in an NHS hospital, as though that trumps what his leader and deputy leader have said about how the NHS should be organised. Utterly ludicrous. UKIP must be the only political party in history that, when asked about its policies, asks us to discount what the leader and deputy leader have said. It is completely nuts. The serious point is what it says about UKIP’s instincts and values that it wants to replace our NHS with a US-style insurance system in which the treatment and care someone gets depends on the cover they can afford, because that is what Nigel Farage’s plan would mean.
	In the US, insurance can cost families up to £10,000 a year. It can cost almost £20,000 to have a baby privately, and treatment for a knee operation can cost £11,000. Imagine the crippling impact that treatment for life-threatening diseases or emergency treatment could have on the finances of an ordinary family in Dudley. Local people are overwhelmingly against that kind of privatisation, and nine out of 10 people told me in this week’s survey that they are totally against any introduction of a US-style health insurance system.
	When I asked the hon. Member for Rochester and Strood about that, he mentioned my constituency and the forthcoming election. If he were here now, I would tell him that I will be telling people in Dudley what UKIP’s policy for our NHS would mean for them every day between now and polling day. When people in Dudley compare our plans for more doctors, nurses and care workers, quicker GP appointments and faster cancer tests and results with the Government’s plans for increased savings, longer waiting lists and redundancies, or with an insurance-based system and more privatisation from UKIP, I am sure they will know who is on their side.

Chloe Smith: It is instructive, as always, to follow the hon. Member for Dudley North (Ian Austin), and I thank him for his exposition of the positions set out around the Chamber this afternoon. I also welcome the comments of my hon. Friend the Member for Wycombe (Steve Baker) in picking up on the needs of areas that might not normally be viewed as deprived, but that need attention none the less. Norwich is one such city, because it contains wards and areas of serious deprivation. I have argued on behalf of GP surgeries that serve those wards, and there is a genuine question about the way our national structures and funding serve those areas.

Steven Baker: Is it not odd how people who are obsessed with inequalities take levels of aggregation that hide the real suffering of individuals and families?

Chloe Smith: My hon. Friend makes a wise point.
	Tomorrow, I am visiting a walk-in centre and the hospital that serves my constituents. When I am there, I shall be explaining, as I have several times in the House recently, my support for the NHS in Norwich and across Britain, my thanks for what the staff are doing and my understanding of what the patients, my constituents, need from the NHS.
	I want to make three points in the debate. My first point is that, as many hon. Members have said this afternoon, the NHS is under unprecedented demand. It does it no disservice to acknowledge that and bring it into the debate. I for one welcome the decisions that allow for increased numbers of doctors and nurses in urgent care—that is true in the Norfolk and Norwich University Hospitals Trust; for an increased number of operations to be carried out each year—that is true everywhere in the country; and for increased hours at GP surgeries. I recently learned to my pleasure that Norwich doctors will apply for the next round of the access fund. They have not done that before and it is very welcome. The Government have made the fund available and it could be of great benefit to patients in my area.
	I am also grateful to the Government for the decisions made early—earlier than ever before—that have allowed for winter pressures to be dealt with. Again, that directly benefits the area of Norfolk that contains the Norfolk and Norwich hospital. I am particularly pleased that the use of that funding will be planned jointly with local authorities through the system resilience group. That is incredibly important. I will turn to that kind of joined-up working in my final remarks.
	Let me make a point about the motion. We have heard wise contributions from Back Benchers on both sides of the Chamber. For example, my hon. Friend the Member for Stafford (Jeremy Lefroy) rightly asked us not to use the name of his area as a shorthand. He is right that we ought to look much deeper. As a further example, the hon. Member for Wirral South (Alison McGovern) rightly spoke eloquently about mental health. Unfortunately she is not in the Chamber, but I am sure she will be back before the winding-up speeches. I intervened on her to ask why the motion does not refer in its own right to mental health; it is a great shame that it does not. The motion is 10 lines of overblown and
	fly-blown rhetoric. It asks for an NHS that is “fit for the future”, but makes no mention of mental health being equal to physical health, which I believe strongly. Mental health and physical health should be equal in word and deed, and in budgets. Indeed, I have been discussing that with the Minister recently through parliamentary questions.
	The truth is that the motion is rather sad and inadequate. It betrays even the usual standards of political football that are played on Opposition days. The right hon. Member for Leigh (Andy Burnham) said in his opening speech that it is time for honesty. To that end, we would like to know whether his party leader believes in “weaponising” the NHS. To that end, we would like an end to the shabby leaflets on the NHS that go around the country.
	I would have liked mental health, which is an important topic, to replace the waste of words in the motion. The motion is a pathetic reuse of the tired and crumbling money-making policy—the mansion tax—that not even all Opposition Members agree with.

Liz Kendall: Will the hon. Lady give way?

Chloe Smith: Perhaps the hon. Lady will explain whether the mansion tax will be spent once or 20 times over, like Labour’s bonus tax.

Liz Kendall: Why is the NHS as a whole not one of the hon. Lady’s Government’s five priorities?

Chloe Smith: The hon. Lady will have heard the Secretary of State speak eloquently on the topic of the Government’s priorities. The point I was about to make is that economic competence allows us to run an NHS securely and strongly for the future. It is the Conservative party and this Government and who are demonstrating such economic competence, thus allowing the NHS to be a priority for the future.
	My final point is much more important than this political to-ing and fro-ing. My hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) made a sensible point about the good that can come from local commissioning and joined-up working. I would add a third point, to make a kind of trinity. The third important thing we all want to see in our local health services is the making of decisions in good time. For example, the walk-in centre in Norwich has recently had to move. As I mentioned, I will be there tomorrow discussing this further with staff and patients. There was no need for the decision to relocate to be made at the last minute. It is a source of great frustration to patients locally that the decision was not confronted earlier on. It was there in black and white in the centre’s rental lease contract, so it was not too hard to spot.
	Patients look to health officials—both locally and, where it applies, nationally—to make sensible decisions on time, and for those decisions to be made locally, wherever possible, and in a joined-up way, as my hon. Friend the Member for Blackpool North and Cleveleys rightly said. I would like the walk-in centre to look to its future by assessing its relationship with accident and emergency, GPs, physical health, mental health and all types of provider, including the voluntary sector, which has not been mentioned in the debate so far. I would
	particularly like decisions about the walk-in centre to be made in good time. There can be no forgiving decisions taken right up to the wire, which fail to deal with the real world as it stands in terms of rental contracts and, most importantly, fail to serve patients best.

Kevin Barron: It is a pleasure to speak in the debate, and to follow the hon. Member for Norwich North (Chloe Smith).
	My hon. Friend the Member for Dudley North (Ian Austin) mentioned private health insurance. In America, 80% of the population have great health care through private health insurance, but for the many people who cannot afford any private health insurance and rely on charity, it degrades very steeply. My parents used to have to rely on charity in the 1930s in this country. If any so-called political party is talking about returning to health insurance, I have to say that people will get what they can afford and the bulk of people will get very little. What Nigel Farage said the other day was completely consistent with UKIP’s 2010 manifesto— I have a copy of it.
	I want to talk briefly about the pressures on accident and emergency. It is no coincidence that when the economy is being run more “efficiently”, as I think the hon. Member for Norwich North put it, through cuts and austerity, there will be an effect on services. Figures from an Age UK report that came out this week show that despite rising demand from growing numbers of people in need of support, the amount spent on social care services for older people has fallen nationally by £1.1 billion, or 14.4%, since 2011, even accounting for additional funding from the NHS, and by a total of £1.4 billion, or 17.7%, since 2005-06. That is quite a large cut.
	According to the Health and Social Care Information Centre, between 2010-11 and 2013, the number of older people receiving home care fell by 31%, from 542,000 to 370,000; the number of day care places plummeted by 66.9%, from 178,000 to 59,000; and the number of older people receiving vital equipment and adaptations to help them remain safely at home dropped by 41.6%. This is the austerity that the people on the Government Benches say our economy needs.

Sarah Newton: rose—

Kevin Barron: In a few minutes—let me get to my third page, and I will gladly give way.
	Spending on home care has dropped since 2011 by 19.4%, from £2.2 billion to £1.8 billion, while the amount spent on day care has fallen even more dramatically, by 30%, from £378 million to £264 million.

Sarah Newton: I read the Age UK report with great interest, but the data, which the hon. Gentleman has cited, is aggregated information from across England. Not all local authorities are cutting social care. Some really good local authorities are coping with the reductions in funding from central Government, prioritising the needs of the most vulnerable people in their communities and finding innovative ways of working with the NHS and the voluntary sector to improve the self-reported well-being of the people they serve. It is not the blanket situation across the UK that he describes.

Kevin Barron: That is not a denial that the figures are true. They are true. These are the facts and figures of what austerity under this Government has introduced to local government and social care.
	The cuts have happened at the same time as the number of people aged 65 and over has increased by 1.2 million. Caroline Abrahams, charity director at Age UK, said:
	“This devastating scorecard speaks for itself and it lays bare the fact that our state funded social care system is in calamitous, quite rapid decline. Today, many hospitals are finding it hard to discharge older people and commentators are asking why this challenge seems to be growing, year on year. A big part of the explanation is revealed by this scorecard: the marked decline in central government funding for social care and the resultant reduction in support for older people to live independently at home - this at the same time as their numbers are rising.”
	She continued:
	“Until recently the impact of the decline in social care has been relatively hidden, but social care is a crucial pressure valve for the NHS and the evidence of what happens when it is too weak to fulfil that function is clear for us all to see.”
	She maps that out pretty well.
	Councillor Izzi Seccombe, of the Local Government Association, said the system was “chronically underfunded”. She said:
	“Councils have protected our most vulnerable people as far as possible, often at the expense of other services, and we will continue to prioritise those most in need.”
	She continued:
	“However, the combined pressures of insufficient funding, growing demand, escalating costs and a 40% cut to local government budgets across this parliament mean that despite councils’ best efforts they are having to make tough decisions about the care services they can provide.”
	This councillor is the Conservative leader of Warwickshire county council—not somebody from an urban area but a Conservative who knows exactly what austerity is creating in Warwickshire, and probably elsewhere as well.
	On 7 January, following an urgent question on A and E and major incidents, I raised in the House an issue about an elderly member of my family. In response to my right hon. Friend the Member for Leigh (Andy Burnham) and me, the Secretary of State mentioned the better care programme but said little else about the problems facing people in hospital. That member of my family was actually my mother, who was in Rotherham hospital, having been admitted to A and E on 9 December. Two days later, she was told she could go home, as there was no medical need for her to be there. She spent her 93rd birthday in Rotherham hospital on 24 December and was discharged on 5 January—with no medical reason to be in that hospital all the time from 11 December until then.
	I have since checked the reductions in my local authority’s adult services budget. This year thus far, the reduction has been over 6%. Over the last full financial year, the reduction was over 8% and previously 4% and 3%. That has a cumulative effect on people’s ability to be looked after in the community. People stand at that Dispatch Box or anywhere else talking about “the need for austerity”, well that shows the price of that austerity. My mum is good; she is back at home with a good care package, and she is fine. She wants to continue on her own as much as she can, but many people cannot do that. If we want austerity, we will have such problems.
	On 7 January, no mention whatever was made on the Front Benches about the situation. Yesterday, the Government acknowledged the impact of social care cuts and announced £25 million-worth of emergency funding for 65 council areas experiencing the most severe delays in discharging elderly patients from hospital. No mention at all was made by the Secretary of State when he opened the debate today. It was hidden away, but it is in the national press if anyone wants to look for it. The Government know the situation: they know what problems have been created in A and E in hospitals up and down the land by these cuts, yet no mention was made, even though the motion specifically mentions A and E problems.
	I shall finish now, but I must say that if people want austerity and if they want to fight a general election on the basis of being better at the economy than the other side, they need to realise the price paid for it. My mum survived it, but many people in this land are not surviving it. In my view, it is not a price worth paying. We need serious change—and I say that not only to the Government Front-Bench team, but to the Opposition Front-Bench team. We need to make serious changes in this country to look after our most needy people. We are not getting that under this Government.

Julian Huppert: It is a pleasure to follow the right hon. Member for Rother Valley (Kevin Barron). We have heard references to Nye Bevan and his amazing work in setting up the NHS. We should talk about Beveridge and his report, too. He was a good Liberal and he did that work during a coalition, albeit a somewhat different coalition that had come about for different reasons.
	Let me start by looking at some issues that have arisen in my area of Cambridgeshire over the last month or so. There has been a number of winter challenges to be faced. Among them, I could talk about the ongoing problems with the ambulance service. The real problem that struck us was, I suspect, when the East Anglian ambulance service changed to the East of England ambulance service—and it has never recovered from that.
	What has hit people most, I think, has been the problems at Addenbrooke’s hospital—a major incident took place, and a large number of operations had to be cancelled. I have spoken to the managers there and to many of the doctors and nurses. It seemed that there were two main reasons for the big problems. One was that Addenbrooke’s has been implementing the new e-hospital system—an exciting electronic records system that is the largest NHS IT project ever to be implemented. It is not as big as the one that was scrapped, but it was implemented. Although it will be a good thing when it is finally working, there have many teething problems along the way and lessons that have to be learned. I suspect that other hospitals will want to learn from this: they should look carefully at the bad things, as well as the good things.
	The other problem is the shortage of care wards, with delayed transfers of care. That has been a problem for a long time. Addenbrooke’s opened some new wards, but more are needed. I have been campaigning for some
	time to re-open some wards at Brookfields hospital, also in Cambridge, and I spoke about this in this place last year. I am delighted that, as of 9 February, these wards will be opened at Brookfields hospital. That is very encouraging. It is interesting to note that, in 2007, there were proposals to close down the entire hospital; I am delighted that we are opening up more wards instead.
	We are trying to solve the problem for the long term through a new older people’s contract. This is the second-largest tender ever put out for the NHS, as it includes all the older people’s services in the county. I am delighted that the contract was won by the NHS—unlike the largest contract. The acute hospitals, the mental health services and the community work sector will all be working together to solve the problems we are having with things such as delayed transfers of care. That is the long-term fix for older people’s services in Cambridgeshire, and I hope it will be a model for other parts of the country to have a look at.
	We have seen the news about Circle pulling out of the Hinchingbrooke hospital. This has been discussed in this place, and it is a shame that the shadow Secretary of State is not in his place, as it is always fascinating to hear him argue that he was in favour of the NHS bid led by Serco. I do not count Serco as part of the NHS, and I do not think that any Opposition Member would wish to do so.

Andrew Gwynne: Will the hon. Gentleman give way?

Julian Huppert: I will give way once on this issue.

Andrew Gwynne: I fear that the hon. Gentleman is, yet again, seeking to rewrite history. He will know that when my right hon. Friend the Member for Leigh (Andy Burnham) became Secretary of State, he changed the “any willing provider” policy to “NHS preferred provider”. That allowed Cambridge University Hospitals NHS Foundation Trust to become a partner of one of the three bidders. It was, of course, the Government whom the hon. Gentleman supports who signed the contract 18 months after the general election.

Julian Huppert: The hon. Gentleman ought to get his facts right. The Cambridge university trust put in a bid—it was the sixth last to do so—but then withdrew because the cost of the tendering process under the right hon. Member for Leigh was far too high. It did not have a partnership with Serco. The hon. Gentleman should check the facts and check the record. The trust was driven out by the tendering. The hon. Gentleman should also know that the bid to which I suspect he was referring was led by Serco. What he is saying, in essence, is that the current shadow Secretary of State had to undo the damage that had been done by previous Secretaries of State. That is a bit of Labour misery that I imagine Labour Members can sort out between them.
	We know the history, and we know the problems that led to it: the Government had to decide between three private sector-led bids for Hinchingbrooke. What we must do now is work out what to do next, and I think we need to ensure that Hinchingbrooke stays in the public sector. Trying to remove it from the public sector in order to deal with the PFI problems, which was the original idea, simply has not worked. It must stay fully within the NHS.
	Last year, before any of this happened, I led a debate about health in Cambridgeshire. I dealt with a number of issues, and I will not go into all the details now, but I spoke about health funding and, in particular, about mental health. I gave a number of detailed examples of some of the many challenges that we have faced and still face. For instance, huge cuts were made five or six years ago. During that debate, I called for a substantial amount of extra money, not just for Cambridgeshire—although I shall say something about that shortly—but for mental health throughout the country. Members in all parts of the House have made some excellent speeches about mental health, but it is not talked about enough. I find it regrettable that the motion does not mention it, and I suspect that a number of Members on both sides of the House do as well. Let us hope that we receive that extra money for mental health.
	Cambridgeshire, however, suffers from a number of specific problems. We have been a test bed for experimentation for many years. We had the Hinchingbrooke experiment— the largest tender that the NHS has ever seen. We saw huge numbers of PFI projects not just at Hinchingbrooke, but at Peterborough. Paying off the NHS costs is still taking 18% of Peterborough hospital’s budget. That is only a small proportion of the 138 PFI projects that we saw under the last Government, the costs of which will amount to £11.7 billion over the next Parliament. That money could be used far more productively.
	We have been hit hard by that, but we also receive very low funding. We inherited a formula from the last Government, and the process of changing it has been too slow under the present Government.

Hugh Bayley: rose—

Julian Huppert: The hon. Gentleman can intervene if he wants to talk about why PFI is a great thing, but otherwise I will move on.
	The Government have been too slow to move to the new formula, which properly takes account of ageing populations. We know that the elderly cost more in terms of health care. Cambridgeshire receives £961 per head, whereas West Norfolk, for example, receives £1,255. That is a huge difference. I asked for extra money during the debate that I mentioned, and I am delighted that we have managed to secure an extra £20 million as a result of the recent allocation. That will provide much more funding for mental health, on top of the extra £1.5 million that has been provided this year and the extra £2.2 million that will be provided for IAPT—improving access to psychological therapies—next year. That will make a big difference, and will reverse some of the challenges that we face.
	We need that extra cash, but we still need more in Cambridgeshire and throughout the country. Simon Stevens called for an extra £8 billion by 2020, after savings and efficiencies had been taken into account. He said that an extra £8 billion, in real terms, was needed if the NHS was to keep going. I think that that is important, and we as a party think that it is the right thing to do. One of the problems with the motion is that it does not deliver what Simon Stevens has said is needed for the NHS. I am not all that keen to support the provision of less than a third of what is needed to keep the NHS going, especially after hearing from the shadow Secretary of State that, despite what the motion
	says, the money is not all for the NHS but constitutes the entire offer for the NHS and social care, which also needs its own funding. We need that £8 billion.
	I voted against the Health and Social Care Act 2012 as I did not agree with much of it. There are some issues, such as parity of esteem, that are very good and that I hope will never be repealed. I also disagree, however, with many of the things that the Labour party did to bring in the private sector in some damaging ways, with people being paid for things that never happened.
	The fact is, as was mentioned by the hon. Member for Brighton, Pavilion (Caroline Lucas), under the previous Government medical spending on private provision went from £1.1 billion a year in 1997 to £7.5 billion in 2009-10. That is a vast increase. I have no problem with people who say that they support that and that it was the right thing to do, but to suggest that that large increase was excellent for the NHS while the fact that it has continued at essentially the same rate under this Government is a disaster for the NHS strikes me as a rather bizarre claim.
	I have criticisms of this Government, the previous Government and the one before that. I want the NHS to spend more of its time focusing on patients or, even better, avoiding the need for people to be patients in the first place. That needs a trained, motivated and well-paid staff—I think they should get the money from the independent review. It needs a focus on prevention and public health and proper funding—that is, the £8 billion by 2020.

Paul Burstow: On that point, does my hon. Friend agree that the better care fund, which is now being launched in April, is a key way in which we can deliver the joined-up care that he is talking about and that we need to have an ambition that by 2018 all CCG budgets, primary care budgets and social care budgets are in that pot?

Julian Huppert: My right hon. Friend is right, of course, and I pay tribute to him for the work he has done on this and on many other health measures. We must ensure that that integration happens so things work together and that is why token amounts such as a couple of billion pounds from the Conservatives, who need to go a lot further, and the £2.5 billion across health and social care from Labour—and by the way, please correct me if I am wrong, but according to The Guardian that is from 2017 onwards —will not go far enough. We need integration through the better care fund and we need that £8 billion. That is the proper funding that is needed.
	Finally, we in this House ought to have a proper debate about how to fix problems and cut back on the amount of partisan bickering that happens in this place. That does not do us proud. We are all prone to it, including me. It is much better to talk about what we can do to promote health, whether it is physical or mental.

Several hon. Members: rose—

Eleanor Laing: Order. I am afraid that I shall have to reduce the time limit to seven minutes and that it will have to be further reduced if people take more than just over six and a half minutes.

Hugh Bayley: NHS services in the vale of York are provided by well-qualified and hard-working staff and this year they received £367 million to provide their services. Nevertheless, services in my city of York are in crisis as a direct result of coalition Government policy.
	The A and E service at York hospital has broken down over the past two months. In December, 71 operations were cancelled at the last minute so the beds could be freed up for emergency admissions from A and E. Between 1 and 11 January this year—11 days—84 operations were cancelled for the same reason. When my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson)do was Secretary of State for Health, he created the walk-in centre in York, which he visited with me, and it reduced pressure on A and E. He created NHS Direct, which reduced pressure on A and E. The walk-in centre was closed two or three years ago and NHS Direct has now been closed, so it is not surprising that we face these extra pressures with hundreds of thousands of extra presentations at A and E each year.
	The pressures in A and E mean that when ambulances arrive with acutely ill patients they often have to wait a long time before they can pass the patient over to the A and E service. That inevitably has a knock-on effect on ambulance response times. A freedom of information request made last week by the trade union Unite found out that Yorkshire ambulance service failed to meet its national target of responding to 75% of emergencies within eight minutes in 11 of the 12 months leading up to October of last year.
	The problems within mental health services are even worse. Last year, the Care Quality Commission highlighted major failings and, following an especially serious incident at Bootham Park hospital, the acute mental health hospital in York, in which a patient died, I wrote to the Secretary of State in April 2014 in support of the local clinical commissioning group and Leeds and York Partnership NHS Foundation Trust, the provider of mental health services in York, to press for urgent plans to replace the 250-year-old Bootham Park hospital. It is a fine grade I listed building, but because of its listed status English Heritage prevents the health trust from removing ligature points or installing anti-barricade doors and makes it impossible to provide clear lines of sight from nursing stations to the patients’ bedrooms.
	The CQC’s concerns are not just about adult mental health services. The child and adolescent mental health unit in York, Lime Trees, was constructed more recently. It is a mixed unit for girls and boys, but it does not have sufficient bathrooms to preserve dignity with two genders within the unit. It also has inadequate space for clinical meetings, therapy sessions and family visits, and it only has limited space for the young people themselves to relax and, because of its deficiencies the more acutely ill young people have to be sent away, often to the other side of the Pennines, in order to get treatment. That does not make sense. We have heard from my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and others today about the pressures on families when acutely mentally ill young people are moved away.
	I got a letter back from the Minister of State saying that NHS Property Services was working with local commissioners
	“to look at a comprehensive estate strategy for York.”
	That was eight months ago, and I say to the Minister—I hope his Parliamentary Private Secretary will tap him on the shoulder now—that I would like him in his response today to say what progress has been made in those eight months in providing a capital package to replace Bootham park hospital in York. It is urgently needed and he has had a long time to consider it.
	Just last week the CQC, in a new report, made further criticism of the Leeds and York mental health trust. Most worryingly of all, it revealed that York receives much poorer services than Leeds, despite the same trust providing services to both places. The local paper in York had a headline story describing it as “A Tale of Two Cities.” The trust chief executive Chris Butler has told me that the reason for the disparity in services is simply because the CCG in Leeds is better resourced than the CCG in the Vale of York and therefore it receives more money per capita for the population served from Leeds than for that served from York. It is simply unacceptable for access to care to depend on a postcode lottery.
	Two things have brought about this crisis. First, there has been a squeeze in funding in the NHS. As I pointed out when the Secretary of State was speaking, the NHS budget has fallen from 8.2% of our GDP in 2009-10 to 7.9% in 2013-14, and the situation is getting worse as we will see when the figures for this year are revealed. To put that fall in perspective, the difference between 8.2% and 7.9% of GDP is some £5 billion a year. That is the amount by which this coalition Government have cut the NHS budget.
	The Government must address not only the overall level of funding, but the way the funding is split between different health authorities. Within the former North Yorkshire primary care trust area, where all patients used to get the same level of treatment, funding in the Vale of York is just £1,062 per person as against £1,270 in Scarborough and Ryedale. I went with colleagues from neighbouring constituencies to see the Secretary of State to say that parity of funding should be restored, but nothing has happened. This is a Government who talk the talk but do not walk the walk on the NHS.

Several hon. Members: rose—

Eleanor Laing: Order. I must reduce the time limit to five minutes if everyone who wants to speak is to have an opportunity so to do.

Liz McInnes: The pressure that the NHS faces in my constituency under this Government is all too apparent. I have a constituent, Mr Stephen Corfield, who asked me to call on him last weekend. Stephen has been housebound for the past year with severe back, hip and neck pain that results in severely restricted mobility. He lives in his upstairs bedroom and is cared for by his wife. He has not been able to go downstairs for a year. Stephen is in dire need of X-rays to diagnose his condition, yet he cannot get to hospital because the privatised ambulance service in Greater Manchester, run by Arriva Transport, will not come out to take him. Arriva says that all Stephen has to do is to get to his front door, at which point its passenger transport system will do the rest. This completely
	overlooks the fact that Stephen is totally incapable of getting to his own front door. Is it any coincidence that Stephen’s problems are being exacerbated by the inaction of a privatised ambulance service? Stephen has to sit at home, his health deteriorating day by day, all for the want of an appropriate, decent response to his problems from that privatised service.
	Other constituents have been to see me to complain about the withdrawal of the diabetic retinopathy screening service from Heywood. This has resulted in diabetics living in Heywood being asked to travel to Rochdale for an essential screening test. The test leaves them with impaired vision, and therefore unable to drive. They have to use public transport, and often have extreme difficulty in doing so. If ever there was an argument for keeping health services local, the diabetic retinopathy screening test is it. As a result of this cut to the service, diabetics in Heywood are not keeping their appointments because they do not feel confident that they will be able to return home safely after their test. The result of the cut is that patients are missing out on an essential test that helps them to maintain their eye health and keep them out of hospital. This is a false economy if ever there was one.
	Sadly, those two examples are all too typical of the patient experience in today’s NHS. Services are being cut and privatised, with an inevitable reduction in quality of care for the patient, and this is all the result of the Health and Social Care Act 2012. The Act was introduced by a coalition Government with no mandate to do so; it was mentioned in neither the Tory nor the Lib Dem manifesto.
	I should like to move on to talk about NHS staff. Not long ago, I was one of them. I worked as a health care scientist and I saw at first hand how demoralised NHS staff had become under this Government. NHS staff are not against change. We have spent our careers working with a background of constant change, but what has happened since 2010 has been unprecedented. Services have been cut and privatised, and staff have been made redundant or TUPE-transferred to private providers. I have seen hard-working colleagues burn out, and many people have taken early retirement if they can afford to do so. They were unable to take the pressure of working in today’s NHS.
	In a spirit of consensus, I should like to suggest to the Secretary of State—were he here—that one easily achievable thing he could do would be to stop ignoring the recommendations of the pay review body that were made last year, and to pay all NHS staff the 1% pay rise they so richly deserve. I cannot understand why this Government have chosen to pick a fight with NHS staff over a 1% pay rise. They cannot possibly be proud of the fact that they have presided over strikes in the NHS. Any Government who can get the not-normally-militant Royal College of Midwives out on strike must surely admit they are doing something wrong.
	NHS staff will strike again next week, simply because the Secretary of State refuses to meet the trade unions to discuss and negotiate the issues. The Secretary of State constantly heaps praise on hard-working NHS staff, yet he refuses to do this one simple thing. If he were to remunerate the staff in this way, it would improve morale, which would have a positive effect on patient care. The NHS is one of this country’s greatest achievements, yet under this Government we have witnessed
	a decline in the quality of care, growing health inequalities and stressed, demoralised staff. The Secretary of State is presiding over strike action in the NHS, yet the simple solution to the strikes lies in his own hands.

Andy Slaughter: It has been a dispiriting afternoon, listening to the Secretary of State and Government Back Benchers saying that they do not play politics with the NHS while doing exactly that by blaming a previous Labour Government. They say they respect and care about NHS staff but they are not even prepared to pay them the 1% increase that has been recommended. Most of all, they say that they care about individual incidents but ignore statistics, whereas those statistics are simply the aggregate of so many individual tragedies that are going on at the moment.
	Let me explain what I mean by that last point. This week, the Evening Standard has been running a series on the London ambulance service, and yesterday it was revealed that the head of the service had resigned after producing the worst results in the country—in only two thirds of the greatest emergency cases did the ambulances arrive within the target time. On Monday, it was reported that there had been a two thirds increase between November and December in stacking—ambulances waiting more than 30 minutes outside hospitals—across London. What those statistics, bad as they are, hide is shown in the e-mails I get every week from my constituents.
	One such e-mail was about an incident where someone on a pizza delivery bike was hit by a car, with the rider badly injured. The police arrived rapidly and administered first aid. They were
	“overheard to say that the victim was bleeding from the ear and his injuries may be ‘life-changing’”,
	but that the fact they had arrived might itself delay an ambulance arriving. In this case, it took an hour an a half for that to happen. Another e-mail was about an elderly man who fell, cut his head and was lying in blood. The neighbours came out to help, but after an hour, during which time no ambulance had arrived, he was helped back into his home. Another e-mail relates to the case of a constituent who came to the aid of somebody who had come off their bicycle and broken their nose on Shepherd’s Bush road. My constituent was told by a paramedic, who was phoning back, that it would be at least two hours before an ambulance arrived, and they managed to get a police officer to take the injured person by minicab to Chelsea and Westminster A and E. I am sorry to say that I get those e-mails every week.
	That is about the ambulance service, but what is happening to A and E? The A and E departments of the Imperial College Healthcare NHS Trust are performing at a level where about one in four people wait more than four hours, but at Christmas it was one in three. In neighbouring hospitals, performance has been as low as having half the people wait more than four hours—for example, at Northwick Park before Christmas. Let me read out what one constituent has written. He is the son of a 94-year-old woman and the following words say it all:
	“She was seen by her GP…and he arranged for her to go to Charing Cross A & E department by ambulance and we arrived there at 6 pm. The department was extremely busy with people waiting in corridors due to a lack of beds.
	Although it was not ideal I agreed with the doctor to start her treatment while she was sitting in the corridor. I say treatment but it was only preliminary things such as taking blood and inserting a line feed in her arm in order to administer antibiotics.
	My mother is incontinent and needs help with going to the toilet. Because the staff were rushed off their feet she could not receive the help she needed in a timely manner.
	It is obvious that the closure of the other A & E departments in West London has had an adverse effect on those that remain open.
	It was not until about midnight”—
	six hours later—
	“that she was given a bed and a room of her own…where finally she was given an examination by another doctor.
	At 1 am I left the hospital and returned the next morning to be told she was being transferred to Hammersmith Hospital because there were no beds available at Charing Cross.
	I think you will agree that this level of care is unacceptable. While I cannot fault the staff at Charing Cross the whole Conservative policy of closures in West London is the worst political decision they have ever made.”
	The point is that I could have been talking about anywhere in England, although in reality the situation in west London is much, much worse. Two of our A and E departments closed last September, and A and E figures plummeted after that. At last night’s meeting of the council committee that scrutinises Imperial College Healthcare NHS Trust managers, I asked whether they would now review—not cancel but simply review–their decision to close the A and E department at Charing Cross hospital, demolish that hospital, lose 93% of the in-patient beds and lose the best hyper-acute stroke unit in the country. Still they would not answer. They would not say yes and they would not say no. They are frozen; they cannot do anything but continue. Perhaps that is why the CQC said that all that trust’s hospitals requirement improvement, why the trust’s foundation status bid is on hold at the moment and why I and several of my west London colleagues have written to the Secretary of State to ask him to intervene. I am not holding my breath. Even though we represent more than 1 million people between us, he has done nothing and has not been willing to meet us for the past two years. That is a disgrace.

Jim Shannon: It is a pleasure to contribute to the debate. I thank the Opposition for bringing the matter to the House for consideration. The one thing that unites the whole House is a love of our health service. We have different opinions on either side of the House, but we are united by the need for an NHS that delivers services for our constituents.
	It is important to look at the regional issues affecting our devolved Administrations, but a nationwide strategy for the overarching issues facing the whole of the UK is of paramount importance. My concerns relate to barriers to accessibility and the quality of NHS provision. I shall focus on the availability of vaccinations and the issue of nationwide strategies. Sometimes we should not be parochial about the NHS, but rather consider nationwide strategies that can be put into practice across the entire United Kingdom of Great Britain and Northern Ireland.
	With the undeniable strain on NHS resources and their ability to provide services efficiently, quickly and to the high standard that we strive to meet, in the past few days the Northern Ireland Assembly announced an extra £203 million for the Department of Health, Social Services and Public Safety. That will alleviate some of the pressure, but there are continuing financial demands to provide the new drugs and new technologies that are vital for the provision of essential services. It is a great pity that as a result of Sinn Fein’s delay in agreeing welfare reform measures, fines were imposed, impacting upon the moneys available.
	As other hon. Members have mentioned, mental health services are struggling to deliver urgent care, particularly for younger people. Some 17% of young people have been sectioned under mental health legislation since 2010. That is an indication of the issues that permeate our whole society. For those of us of a certain vintage and those of us who are younger, the issues of mental health are clear.
	Cancer care is a subject close to my heart. One in every two of us is expected to have cancer. The devolved Administration in Northern Ireland have been maintaining funding for clinical trials that will benefit the whole of the United Kingdom, but it is a challenge to find the money for that. The statistics from Cancer Research UK emphasise the prevalence of the disease: every two minutes someone in the UK is diagnosed with cancer. The NHS must deliver the necessary care.
	The Northern Ireland Budget has made promising provision for health. The demand for health care is greater in Northern Ireland than in the rest of the United Kingdom. How we deliver that care, how we manage our services, and what preventive strategies are in place are all crucial aspects. The problems affecting A and E departments in Northern Ireland are as acute as those in some parts of the mainland. Education campaigns in GP surgeries and on television and radio could encourage people to use A and E departments appropriately and to consider using the other systems that are in place.
	In Northern Ireland we seek to increase the number of patients participating in clinical trials, but we need to maintain the funding for that and meet the costs involved, among the many other demands on the NHS budget.
	I know that the Minister is usually responsive on the issue of cancer drugs, so in his summing up perhaps he will explain why six cancer drugs have been reduced, restricted or withdrawn and how that fits in with the strategy across the whole United Kingdom.
	I want to put on record my thanks to our medical practitioners and nurses for the hard work that they do. Will the Minister consider increasing the number of agency staff on a contract basis to assist in alleviating the pressures on NHS services, or will he consider some sort of scheme whereby graduates are brought in to help them gain experience and training? This would not only benefit young people who need experience, but would put more staff on hospital wards and in A and Es, and could be financed from the existing budget.

Yasmin Qureshi: I wish to start by thanking NHS staff. I agree with the Secretary of State that they should be recognised for all their
	work, so I ask him to consider giving them the 1% pay rise that has been recommended by an independent body. That would be a real way of recognising all their hard work.
	I wish to talk about the Royal Bolton hospital in my constituency; it is the third largest accident and emergency department in the north-west. Last year, it saw 114,510 people. A and E admissions numbered 26,267 and in 2013-14, elective operations stood at 14,865 and non-elective at 1,407. The staff—porters, cleaners, care assistants and clinical staff—do an excellent job in a very difficult situation. My hospital needs more resources.
	As I attend regular meetings with the chief executive officer and the chair of the Royal Bolton hospital, I also often visit the A and E department to see the situation at first hand. Recently, the hospital declared a major incident when it could not take in 76 patients. By cancelling non-emergency elective operations, it managed to free 40 beds. However, as a consequence of cancelling those operations, it lost £600,000.
	As the hospital will now no longer be able to meet the target of the clinical commissioning group, it will end up getting penalised as well. To meet that target, the hospital may have to resort to using private companies, which may cost it even more. Whichever way we look at it, the hospital stands to lose quite a lot of money. Over the past two years, it has had to make £40 million of cost savings, and it will have to carry on cutting in light of the demands that it is facing.
	The main reason for the long waits in A and E was that many people could not get GP appointments or go to walk-in centres, so they had to go to A and E as a first port of call rather than as a last one. Secondly, many elderly and frail people could not be discharged, which then led to bed blocking. There were 94,046 acute delayed days last November, which then created even bigger blockages. The hospital is caught bang in the middle of the problem—there are problems at the start, before people go to hospital, and there are problems at the end, because people are not being transferred or discharged. That situation must change. One reason for the delays in transfers and discharges is the cut in the budget for social services and adult care. More than 300,000 people no longer receive state funding for social care.
	In 2009-2010, the Labour Government spent 8.2% of GDP on the NHS, whereas in 2013-14, the figure was 7.9%. It is quite clear, therefore, that less money is going into the sector. It has been recognised in this Chamber that, with more people living longer and with growing health needs, that money has to go up. To say that nothing further can be done with regards to putting more finance into hospitals is completely wrong.
	In Bolton, the local authority, the hospital and the clinical commissioning group are trying to work together. When I recently visited my local A and E, 17 cubicles were in full use and two people were on trolleys. The situation is not good enough, because Bolton is an incredibly large area, serving about 300,000 people. People from Wigan and other surrounding areas also use the hospital.
	Another problem is the shortage of GPs and the fact that walk-in centres have been closed down. We know that we need at least another 400 GPs and more walk-in centres. If we had an increase in those areas, the problem
	would not be so acute. Finally, not enough nurses are being trained, which will lead to a big shortage. That is another tsunami waiting to happen.

Mr Speaker: I am immensely grateful to the hon. Lady.

Liz Kendall: It is a privilege to speak in this debate, which has seen some passionate and thoughtful contributions about the NHS. Many hon. Members spoke about the pressures on their local ambulance services and A and E departments, including the hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Barrow and Furness (John Woodcock), for Penistone and Stocksbridge (Angela Smith), for Heywood and Middleton (Liz McInnes), for Hammersmith (Mr Slaughter) and for Bolton South East (Yasmin Qureshi). The hon. Member for Stafford (Jeremy Lefroy) and my hon. Friends the Members for Jarrow (Mr Hepburn) and for Wirral South (Alison McGovern) spoke about the closure of walk-in centres, and difficulties in getting a GP appointment, which are piling pressure on their local hospitals.
	My right hon. Friends the Members for Holborn and St Pancras (Frank Dobson) and for Rother Valley (Kevin Barron) described the terrible impact that this Government’s cuts to social care are having on elderly and disabled people, piling further pressure on the NHS, as Age UK’s excellent report showed yet again today. My hon. Friends the Members for York Central (Sir Hugh Bayley) and for Kingston upon Hull West and Hessle (Alan Johnson) spoke about the problems with child and adolescent mental health services, which have seen their constituents, like mine, sent thousands of miles away from family and friends to get treatment, which is terrible for them, terrible for their families and costs the taxpayer far more.
	We have heard time and again during the debate how many of the long, hard fought-for gains achieved under the previous Government are being squandered before our eyes. When we left office, 98% of patients were seen within four hours in hospital A and E departments. Now that is down to 84%, with 180,000 patients having waited for more than four hours in the last month alone. In 2010, 80% of people could get a GP appointment within 48 hours; now one in four wait a week or more or cannot get an appointment at all.
	The maximum 18-week wait for treatment has been missed for the last six months. Cancelled operations and delayed discharges from hospital have reached record highs in recent months. The vital cancer waiting target has been missed for the last nine months, meaning that 15,000 people have had to wait more than 62 days to start their cancer treatment. Anyone who has had a family member or friend wait for that treatment to start knows just how frightening that can be.
	Ministers repeatedly claim that these problems are nothing to do with them and are simply the result of people living longer. But when our population is ageing, when more people are living with long-term chronic conditions and when the NHS faces the tightest financial settlement of its life, we should not cut the very services that help keep people out of hospital and living at home, which is better for them and better for the
	taxpayer. We should not remove the very incentives that improved GP access and close a quarter of walk-in centres, so that more people end up in A and E.
	We should not slash social care budgets by £3.5 billion, so that half a million fewer of the most vulnerable older and disabled people cannot get help to get up, washed, dressed and fed. Forty per cent. fewer people get home adaptations such as grab rails, which prevent falls, and 220,000 fewer people get meals on wheels. We should not cut 2,000 district and community nurses, who are essential to helping elderly people get back home from hospital, and prevent people with long-term conditions ending up in hospital in the first place. We should not cut training places, so that hospitals are now spending £2.5 billion on more expensive agency staff and hospitals such as mine in Leicester have had to recruit 260 nurses from Spain and Portugal.
	Moreover, as my hon. Friend the Member for Dudley North (Ian Austin) and my right hon. Friend the Member for Tottenham (Mr Lammy) so powerfully explained, we should not force through the biggest back-room reorganisation in the history of the NHS, wasting £3 billion, distracting the entire system, making thousands of people redundant only to re-employ them elsewhere in the system, and creating even more layers of bureaucracy, so that no one knows who is responsible or accountable for leading the changes that patients need on the ground.
	In case the House needs reminding, I should say that the Government have created not only NHS England, alongside Monitor, the Care Quality Commission and the Trust Development Authority, but regional NHS England teams, local area teams and commissioning support units, as well as clinical commissioning groups and health and wellbeing boards. No wonder there is so little leadership in the system.
	Labour Members make no apology for holding this Government to account for their record. After all, their Prime Minister promised people that his top priority in government could be summed up in three letters: NHS. I would hate to see what happened in a service he is not so bothered about.
	Labour Members know that people want hope—the hope that there is a proper plan to get the NHS back on track. That is exactly what Labour will deliver. We have set out our plans for immediate action to ease the strain on A and Es by making sure that there are enough GPs in emergency departments and enough clinicians on NHS 111; stopping walk-in centres from closing; getting nurses to return to practice; and making sure that councils, the NHS and voluntary organisations identify the older people who are most at risk of going into hospital so that they get the right support to stay at home.
	We have also set out a long-term plan for investment and reform so that our care services are fit for the future. We will provide an extra £2.5 billion on top of this Government’s plans to get the GPs, nurses and home care workers we need to transform services in the community and at home.

Stewart Jackson: Despite the £40 million structural deficit and a dodgy PFI deal that the right hon. Member for Leigh (Andy Burnham)
	shackled my local hospital to, in the past four years we have increased the number of nurses by 14% and the number of doctors by 9%. On the subject of apologies, would the hon. Lady like to apologise for her party’s dodgy £63 billion encumbrance of PFI off-balance-sheet deals that have been forced on my constituents and others?

Ian Austin: On a point of order, Mr Speaker. Is it in order for someone who has not been in the debate at all this afternoon to stand up and make these sorts of points during the wind-ups?

Mr Speaker: There is no breach of order; that is a matter of taste and judgment for individual Members.

Liz Kendall: I make no apology for my party’s record on the NHS. When we came into government, people were dying on waiting lists for operations. People could not get to see their GPs, and mental health services had suffered. I would have thought that the hon. Gentleman would be pro reforms that help to keep his elderly constituents at home and oppose the cuts to social care that make that so much more difficult.
	We have set out our plans to bring together physical, mental and social care across primary and secondary services in a single service to deliver truly personalised care and support, shift the focus to prevention, and get the best value for taxpayers’ money. We are going to help family carers get the health checks and breaks they need to stop them from reaching crisis point, and give them one point of contact with care services so that they do not have to battle all the different services.
	We have a radical programme to improve public health, which is the biggest long-term challenge we face, by helping people to do more to help themselves: setting limits on sugar, salt and fat in food marketed to children; improving food labelling to tackle the impending obesity crisis; and taking tough action on tobacco, which this Government have abjectly failed to do. We have a bold national ambition to transform physical activity in our schools, communities and workplaces. That is what we need to put the NHS on a sustainable track in future by making sure that the health of our population improves.
	People want a serious Government who face up to the problems in the NHS, not deny they exist or try to sweep them under the carpet. They want a Government who will deliver the real investment and real reforms we need to make sure that our care services are fit for the future. They want competence, not chaos, and a long-term plan that puts the NHS on the real road to a strong recovery. That is what Labour will deliver. I commend this motion to the House.

Norman Lamb: The NHS across the UK, including urgent and emergency care services, is facing enormous challenges. By the end of this Parliament, there will be nearly 1 million more over-65s than there were at its start, which means substantially more patients with more complex health needs, but such pressures are not unique to England. All hon. Members need to think very carefully about how we pursue the debate on the challenges and pressures that the NHS is facing. Patients and the NHS do not need or want cynicism and party point
	scoring. My right hon. Friend the Member for Chelmsford (Mr Burns) and my hon. Friend the Member for Cambridge (Dr Huppert) were absolutely correct to make that point.

Sarah Newton: Does my right hon. Friend agree that the pioneer programme in Cornwall is really leading the way, with the provisional results showing a 41% reduction in A and E and in-patient visits?

Norman Lamb: My hon. Friend makes a very good point. The Cornwall pioneer programme is doing the most amazing work making innovative change, involving Age UK alongside local doctors, and it is delivering real results.
	Why does the Labour party make constant claims that the NHS in England is in crisis, when the position is so much worse in Wales, where Labour is in power?

Ian Austin: Will the Minister give way?

Norman Lamb: In a moment.
	Why does the Labour party claim that the reforms are to blame when there has been no reform in Wales, yet the position there is worse? What people need and want is an open and honest debate about what should be done to secure the future of the NHS. The motion is about the pursuit of votes, not the interests of patients. If Labour Members—

Several hon. Members: rose—

Norman Lamb: Let me make this point.
	If Labour Members are concerned about the interests of patients, why do they not agree to the suggestion by Professor Bruce Keogh, a respected clinician, for an investigation into safety in the Welsh NHS? Why do they remain silent?

Andy Burnham: The Minister accuses us of bringing politics into the NHS, but did not he and his colleagues put politics at its heart when they signed up to a Tory agenda to put market forces at the heart of the national health service?

Norman Lamb: That is absolute rubbish. Indeed, one of the right hon. Gentleman’s predecessors, the right hon. Member for Hull West and somewhere—

Mr Speaker: The right hon. Member for Kingston upon Hull West and Hessle, rather than “somewhere”.

Norman Lamb: I apologise, Mr Speaker. The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) spoke very candidly about the role of the private sector under the previous Labour Government, which the shadow Secretary of State constantly seeks to deny.

Ian Austin: Will the Minister give way?

Norman Lamb: No. I need to make progress, and I have very little time.
	In a Guardian debate yesterday, in which I took part, Peter Carter, the respected chief executive of the Royal College of Nursing, spoke of the need for political consensus
	“so that we stop this ridiculous points-scoring”,
	which
	“frankly is destructive and does nothing to enhance the quality of the debate.”
	Let us take his plea on board. I have argued for a non-partisan review of NHS and care budgets this year —whoever is in power—which would engage the public. We should all commit to that.
	Labour claims that it will increase funding, but its proposed way of doing so appears to be unravelling before our eyes. Lord Mandelson has described the mansion tax as “sort of crude” and “sort of short-termist”. In the debate, the hon. Member for Hackney North and Stoke Newington (Ms Abbott) cast doubt on how much the policy would raise.
	Before I address the main issues, I want to pick up the remarks made by the right hon. Member for Kingston upon Hull West and Hessle, who raised important issues about mental health. He talked about the case of his constituent, Beth. It is intolerable that she has been shunted around the country. I have met the right hon. Gentleman, and I am happy to engage with him again. It is unacceptable for this to continue to happen. That is why there is an urgent need for children’s mental health services to be reformed, and our taskforce will soon report on the essential changes that are necessary.

Liz Kendall: Will the Minister give way?

Norman Lamb: I do not have time.
	I am pleased that the right hon. Member for Kingston upon Hull West and Hessle endorsed the case for access and waiting times standards in mental health, which I think will have the same transformative effect as they had in cancer care when his party was in government. As my hon. Friend the Member for Norwich North (Chloe Smith) said, why is mental health not in the motion? It certainly ought to be.

Liz Kendall: Will the Minister give way?

Norman Lamb: Let me make this point.
	I acknowledge that several Members, including the hon. Members for Penistone and Stocksbridge (Angela Smith) and for Barrow and Furness (John Woodcock), raised distressing cases. I offer my personal sympathies to everyone who has been let down by the system. Such cases should motivate us all to strive to do everything that we can to improve how our NHS operates and to address the areas where it falls short.
	The Opposition claim that the move from NHS Direct to NHS 111 has increased the demand faced by accident and emergency departments. There is no evidence to support that claim. Only 8% of calls result in a recommendation to go to A and E, and 30% of callers say that they would have gone to A and E if NHS 111 had not been available.
	An accusation has been made about the impact of local authority cuts on social care. I remind the Labour party that the Government were faced with a £160 billion black hole in the public finances and had to act to sort
	that out. There is still no proposal from the Labour party to increase the funding for social care. The claims that it makes are hollow, without the money to go with them.
	Let us look at one of the key indicators: delayed discharges from hospital. From August 2010 to November 2014, delayed days attributable solely to social care decreased from 38,324 to 37,000. The position is not as simple as some people suggest. Social care is performing incredibly well under difficult circumstances. In Cambridgeshire, there is the brilliant development of a service for older people to address their needs in innovative ways.
	It has been claimed that the closure of walk-in centres has led to the current pressures on A and E. Again, we need to look at the evidence. A report by Monitor found that the reasons why local commissioners decided to close walk-in centres included that they were replacing them with urgent care centres co-located with A and E departments or other models of integrating primary care staff in A and E departments. The situation is not as simple as is suggested by the claim that walk-in centres have been closed and A and E has been left to pick up the burden.
	The Opposition have said that the ambulance service is failing. In fact, ambulance services nationally are delivering nearly 2,000 more emergency journeys every day than in 2010. Ambulances respond to the majority of life-threatening cases in less than eight minutes. The Government have provided an additional £50 million to support ambulance services through this winter. It is right to take clinical advice to ensure that target response times are clinically based to avoid the unintended consequences of ambulance crews being driven crazy in the pursuit of targets, when it is patient safety that should be prioritised.
	I come to the solution. In the short term, the Government have made an additional £700 million available to the NHS to cope with the pressures this winter. The right hon. Member for Tottenham (Mr Lammy) did at least acknowledge that. In the longer term, we need to focus on stopping the crises from occurring in the first place. We need a much greater focus on prevention, better integration of health and social care, and the implementation of Simon Stevens’s forward view.
	I thank NHS staff for the amazing work that they do, often under great pressure, and the tremendous commitment that they make. We owe it to them and to the public to ensure that our NHS is protected and enhanced. Most people who use urgent and emergency care services receive effective, timely treatment. That is as it should be. Patients and their families should get the right advice and should get a response when they need it. We set the toughest standards in the world, and rightly so. We all know that those standards are under pressure across the UK, so let us be open and honest about that.

Alan Campbell: claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.
	The House divided:
	Ayes 228, Noes 312.

Question accordingly negatived.

DEFERRED DIVISIONS

Motion made, and Question put forthwith (Standing Order No. 41A(3)),
	That, at this day’s sitting, Standing Order 41A (Deferred divisions) shall not apply to the Motion in the name of Secretary Theresa May relating to the Prevention and Suppression of Terrorism.—(Mr Wallace.)
	Question agreed to.

Prevention and Suppression of Terrorism

James Brokenshire: I beg to move,
	That the draft Terrorism Act 2000 (Proscribed Organisations) (Amendment) Order 2015, which was laid before this House on 19 January, be approved.
	Seventeen people were killed and a number injured in the appalling attacks in Paris earlier this month, while in December we saw deadly and callous attacks in Sydney and Pakistan. There can be no doubt that the terrorist threat we face is grave and relentless. The threat level in the UK, which is set by the independent Joint Terrorism Analysis Centre, remains at “severe”, meaning that a terrorist attack in our country is highly likely and could occur without warning.
	We can never entirely eliminate the threat from terrorism, but we are determined to do all to minimise the threat from terrorism to the UK and our interests abroad, and proscription is an important part of the Government’s strategy to disrupt terrorist activities. The two groups we propose to add to the list of terrorist organisations, amending schedule 2 to the Terrorism Act 2000, are Jund al-Aqsa, also known as the Soldiers of al-Aqsa, and Jund al-Khalifa-Algeria, also known as the Soldiers of the Caliphate. This is the 17th proscription order under the Act.
	Under section 3 of the Terrorism Act 2000, the Home Secretary has the power to proscribe an organisation if she believes it is currently concerned in terrorism. Given its wide-ranging impact, the Home Secretary exercises her power to proscribe only after thoroughly reviewing the available evidence on the organisation. The cross-Government proscription review group supports the Home Secretary in her decision making process. Having carefully considered all the evidence, the Home Secretary believes that Jund al-Aqsa and Jund al-Khalifa-Algeria are both currently concerned in terrorism.
	Jund al-Aqsa is a splinter group of the al-Nusra front, al-Qaeda’s affiliate in Syria. Since September 2013, the group has acted against the Syrian Government. It is a foreign fighter battalion comprising a variety of nationalities, as well as a native Syrian contingent. The group is primarily operating in Idlib and Hama. It is believed to be responsible for the attack on 9 February 2014 in Maan village, which killed 40 people, of whom 21 were civilians. In July 2014, it supported the Islamic Front in an operation to seize Hama military airport. In August 2014, the al-Nusra front released a document summarising its operations that included details of an attack targeting a resort hotel conducted in collaboration with Jund al-Aqsa.
	Jund al-Khalifa-Algeria is an Islamist militant group believed to be made up of members of dormant al-Qaeda cells. It announced its allegiance to the Islamic State of Iraq and the Levant in a communiqué released on 13 September 2014. In April 2014, it claimed responsibility for an ambush on a convoy that killed 11 members of the Algerian army. On 24 September 2014, the group beheaded a mountaineering guide, Hervé Gourdel, a French national. The abduction was announced on the same day that the spokesman for ISIL warned that it
	would target Americans and other western citizens, especially the French, after French jets joined the US in carrying out strikes in Iraq on ISIL targets.
	In conclusion, I believe it right to add both groups to the list of proscribed organisations in schedule 2 to the Terrorism Act 2000. Subject to the agreement of this House and the other place, the order will come into force on Friday 23 January.

Diana Johnson: I thank the Minister for his statement and I am grateful for the Home Secretary’s letter to my right hon. Friend the shadow Home Secretary. On the basis of the Minister’s statement and that letter, the Opposition will support the Government’s motion.
	We recognise, of course, that events in Syria, Iraq and northern Africa are fuelling a rapidly evolving network of inter-related terror groups who pose a real threat to the UK and our allies. It is absolutely right to use all legal measures to try to counter the spread of these groups and to ensure that they cannot establish themselves in the United Kingdom.
	In this case, we have two groups with close links to other proscribed groups. Jund al Khalifa-Algeria is an Algerian-based Islamic militant group, linked to al-Qaeda and hoping to establish a caliphate in northern Africa. The group is affiliated to the Islamic State of Iraq and the Levant. Secondly, Jund al-Aqsa or Soldiers of al-Aqsa is a splinter group of the al-Nusra front, and it is just three months since we proscribed JKI—Army of the Islamic Caliphate, another splinter group of the al-Nusra front. In common with the al-Nusra front, the JAA is largely based in Syria, and as a group has attracted many jihadists from outside Syria. JAA started out as a campaign against the Syrian Government, but in recent attacks the group has seemed happy to target innocent civilians.
	At this point in a proscription order, I normally have to conclude that we will take the assurances of the Home Secretary that she has sufficient evidence that the groups are conducting the activities described. This is obviously because the Opposition do not have access to the same intelligence as the Government. In this case, however, there is no need to see sensitive information to conclude that these are terrorist groups. Far from hiding their activities, they are actively boasting about them on social media, using YouTube, Facebook and Twitter to spread images of the most horrendous violence, alongside messages justifying it. These are not groups that want to hide; these are groups that are actively recruiting.
	The JAA YouTube channel was opened on the 28 July 2014, apparently replacing a previous YouTube channel that had been closed down. The latest Twitter account opened in September in English, again replacing an account that had been closed down. The English Twitter account—we looked at it just yesterday—has 1,460 followers. Tweets declare fallen supporters to be martyrs, and there are links to YouTube videos and other Twitter pages run by JAA. One of these pages is the official JAA Twitter page in Arabic, which has some 17,500 followers.
	The videos on the YouTube channel are even more disturbing. Let us take, for example, the video uploaded on to the official JAA channel on 21 September 2014.
	This video depicts JAA fighters engaging with Government forces—kicking, hanging, abusing the bodies of the dead and taking part in training exercises. It seems quite clear that this video is intended to glorify grotesque violence as a form of extremist propaganda. This video has been viewed 13,000 times, attracted 40 comments and has been “liked” on the YouTube rating system 96 times.
	I have met Google in the past to discuss YouTube’s hosting of terrorist propaganda, and it is supposed to be taking down extremist content when it comes across it. The Home Office’s counter-terrorism internet referral unit is also supposed to be identifying this content and getting it taken down. Here, however, is a whole YouTube channel run by, as we know, a known terrorist organisation and including sermons advocating terrorism and videos of violent terrorist acts attracting thousands of views.
	At one level, there is an irony that these extremist terrorist groups, rallying against western consumerism, are happy to use these enormous western companies to spread their message of hate, but there is also a very serious point. As the Minister said in an earlier speech to the House, the
	“effect is that a listed organisation is outlawed and is unable to operate in the UK. It is a criminal offence for a person to belong to…support…arrange a meeting in support of a proscribed organisation, or wear clothing or carry articles in public which arouse reasonable suspicion that an individual is a member or supporter of a proscribed organisation.”—[Official Report, 2 April 2014; Vol. 578, c. 948.]
	A very brief look at what was available on social media enabled me to come across deeply offensive and worrying videos and tweets. I am very pleased that we are proscribing the organisations that produced them, but I think that the Minister should bear in mind that social media companies are making such videos and tweets available for everyone to see, and consider what more can be done about those companies.

Keith Vaz: I will be very brief.
	As is normal in the case of proscription orders, the whole House is united in support of what the Government are doing. As far as I can remember, no order of this kind has ever being opposed, because we trust and accept the good faith of the Minister when he tells the House that dreadful organisations are seeking to propagate terrorism, which is indeed true.
	I am glad that my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) raised the issue of the internet. As the Prime Minister said recently, it is the “dark net” that gives so much succour to those who are indulging in terrorist activities. The Home Affairs Committee has tried to encourage internet companies to take firmer action on many occasions, but, as the Minister knows, this material is still on the net as we speak.
	Many organisations such as those that we are proscribing today recruit through the net. In the past, there was one-to-one grooming of those who wished to become jihadists; that activity then moved to the madrassahs and then to the universities, and it is now taking place in our prisons. It is, however, the internet through which organisations that seek to change the face of Governments —in Algeria, in particular—are operating.
	I hope that the Minister will continue to do what I know he has started to do, and ensure that the net is free from these agents of destruction. I am happy to support the order.

Hugh Bayley: The hour is late, and I do not intend to detain the House. I think that the Government are right to proscribe Jund Al-Aqsa and Jund al-Khalifa-Algeria. However, as was pointed out by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), it is important not just to proscribe terrorist organisations, but to work to reduce their influence—and, indeed, that of other organisations that the Government may be forced to proscribe in months to come—on young people in our country.
	The protest that took place on the Sunday after the appalling killings in Paris united the whole of Europe, and people from beyond Europe. It is difficult to think of any other demonstration that could have brought together the President of Palestine and the Prime Minister of Israel, who walked side by side. However, if we are to prevent young minds in this country from being poisoned by propaganda of this kind—particularly through the web—it is important for us to work with Muslims in this country. The vast majority of them have absolutely no truck with violence, which they consider to be a denial of the principles of Islam, but we need to ensure that they counter, within their own community, the lies and falsehoods that the terrorists are propagating.
	More Muslim parents are talking to me in York, which does not have a particularly large Muslim population. They tell me that they want more to be done to deflect young people from these dangers. I hope that the Minister will say a little about what the Government are doing in relation to Muslims in this country.

James Brokenshire: With the leave of the House, and in thanking right hon. and hon. Members for their support for the order this evening, let me respond first to the shadow Minister, the hon. Member for Kingston upon Hull North (Diana Johnson). Yes, of course we are vigilant in seeking to combat the use of messages on Facebook, YouTube, Twitter or any other social media platform, including the new ones that appear. That is precisely why we have the counter-terrorism internet referral unit with which the hon. Lady will be familiar. It has taken down 72,000 individual items since it was established in 2010. She highlighted a video and the original has been removed, but it continues to be put up in different places. That is why we have the CTIRU to flag that and to work with industry to take it down.
	The hon. Lady and other right hon. and hon. Members made a broader point about the role and responsibility of the internet industry. We are obviously flagging these items, but the industry has a responsibility to take action when it identifies such images. A number of companies do that, but there is more to be done for them to realise their responsibilities and take further action. Indeed, the Prime Minister’s comments on this subject after the publication of the Intelligence and Security Committee’s report on Woolwich identified that challenge and how we all need to do more. The social media companies and the internet industry certainly need to do more.
	I entirely endorse the comments made by the hon. Member for York Central (Sir Hugh Bayley) about working with communities. That is precisely the approach the Government take. We are seeking to ensure that we challenge ourselves on what more we can do and that is why the provisions in the Counter-Terrorism and Security Bill, which is currently in the other place, put on a statutory basis our work on counter-radicalisation and the Channel de-radicalisation programmes.
	We are doing work in government, but there is also work in communities. Some incredible British Muslims are taking a stand and showing leadership, such as the 100 imams who wrote a letter condemning the actions of ISIL and groups such as Families Against Stress and Trauma. Through their programmes, there is an outlet that prevents people from being radicalised and going down that pathway. This is clearly a broader and wider debate. We have debated some of it on the Counter-Terrorism and Security Bill, but proscription can be an important way for the police to get further evidence, which can lead to prosecution of those who belong to groups that are not proscribed.
	I am grateful to the House for the support it has shown this evening. I hope that we will remain vigilant, whether online, in communities or more broadly, to ensure that we do our utmost to protect our country and our citizens and to confound and confront those who would do us harm.
	Question put and agreed to.

Business without Debate
	 — 
	Delegated Legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Social Security

That the draft State Pension Regulations 2015, which were laid before this House on 26 November 2014, be approved.— (Mr Wallace.)
	Question agreed to.

Eleanor Laing: With the leave of the House, we shall take motions 5 to 8 together.
	Motion made, and Question put forthwith (Standing Order No. 118(6)),

Social Care

That the draft Care and Support (Market Oversight Criteria) Regulations 2014, which were laid before this House on 3 December 2014, be approved.
	That the draft Care and Support (Business Failure) Regulations 2014, which were laid before this House on 3 December 2014, be approved.
	That the draft Care and Support (Eligibility Criteria) Regulations 2014, which were laid before this House on 3 December 2014, be approved.)
	That the draft Care and Support (Children’s Carers) Regulations 2014, which were laid before this House on 3 December 2014, be approved.—(Mr Wallace.)
	Question agreed to.
	Motion made, and Question put forthwith (Standing Order No. 118(6)),

Road Traffic

That the draft Motor Vehicles (Wearing of Seat Belts) (Amendment) Regulations 2015, which were laid before this House on 8 December 2014, be approved.—(Mr Wallace.)
	Question agreed to.

Eleanor Laing: With the leave of the House, we shall take motions 10 to 12 together.
	Motion made, and Question put forthwith (Standing Order No. 118(6)),

Energy

That the draft Renewable Heat Incentive Scheme (Amendment) Regulations 2015, which were laid before this House on 15 December 2014, be approved.
	That the draft Domestic Renewable Heat Incentive Scheme (Amendment) Regulations 2015, which were laid before this House on 15 December 2014, be approved.
	That the draft Renewable Heat Incentive Scheme and Domestic Renewable Heat Incentive Scheme (Amendment) Regulations 2015, which were laid before this House on 15 December 2014, be approved.—(Mr Wallace.)
	Question agreed to.

PETITION
	 — 
	Rules on marches and demonstrations

Sarah Champion: I am presenting this petition on behalf of the businesses and residents of Rotherham who have signed a paper and online petition to try to get the Government to recognise the devastating impact repeat marches in our town centre on Saturdays are having on our economy and sense of community.
	The petition states:
	“The Petitioners therefore request that the House of Commons urges the Government to consider the rules regarding marches and demonstrations, including looking specifically at the thresholds that are used to ban marches and demonstrations so that they include a provision to consider the economic impact of such marches as well as looking at the restrictions that are in place on the frequency, location, time or date of marches and demonstrations.”
	Following is the full text of the petition:
	[The Petition of residents of the UK,
	Declares that the threshold to ban marches and demonstrations is currently measured in terms of public safety, not economic impact; further that there are currently no restrictions on the frequency, location, time and date of marches; further that the Petitioners believe that marches and demonstrations are having an impact on the lives and trades of residents in Rotherham; further that the Police and local council in Rotherham have tried their best to minimise the disruption to traders in Rotherham of marches and demonstrations to ensure that businesses stay open; further that when marches and demonstrations occur in Rotherham significant parts of the town have to close; further that the Petitioners believe such protests and marches are having a devastating impact on local communities; and further that a local petition in Rotherham on this subject has received nearly 300 signatures.
	The Petitioners therefore request that the House of Commons urges the Government to consider the rules regarding marches and demonstrations, including looking 
	specifically at the thresholds that are used to ban marches and demonstrations so that they include a provision to consider the economic impact of such marches as well as looking at the restrictions that are in place on the frequency, location, time or date of marches and demonstrations.
	And the Petitioners remain, etc.]
	[P001425]

STANDARDISED PACKAGING (TOBACCO PRODUCTS)

Motion made, and Question proposed, That this House do now adjourn.—(Mr Wallace.)

Ann McKechin: There are now only a few weeks until Parliament dissolves, but tonight I want to urge the Government that even at this eleventh hour they can still do something that can save hundreds, if not thousands, of people across the country from a premature death. They still just have the time to undertake one major reform that they promised long ago: the introduction of plain packaging for cigarettes. However, despite almost three years of consultations and reviews and clear evidence both at home and abroad to support regulation there has been a deafening silence for over eight months. Why is the Prime Minister prevaricating? I hope the Minister can answer that question this evening and show her resolve to be serious about this nation’s public health.
	We have debated this issue many times but the need for tonight’s debate is simple: plain packaging works. Too many people suffer from diseases brought on by smoking and too many young people are still picking up the habit for the issue to be ignored until after the election.
	Sadly, my own city, Glasgow, has one of the worst records for smoking-related premature deaths in the country. Of those who take up smoking, only about half will manage to stop before they die, and two thirds of current smokers started before they were 18 years old, so the early teenage years are the key period to hook people into the habit.
	The cost to patients, their families and our NHS is still too high despite the considerable improvements in treatments and drugs over recent years. In Glasgow, according to the latest Scottish Public Health Observatory’s tobacco control profile there were over 1,900 deaths from lung cancer in 2012 alone and almost 47,000 smoking-attributable hospital admissions over that year. Almost 28% of the city’s population smokes against the Scottish national average of 23%. Even a small percentage drop in those figures would make a really big difference to a lot of people, save lives and alleviate the pressure on our health services.
	Successive Governments over recent years have put in place a range of measures to assist public health. Duty on cigarettes has been routinely increased in Budgets above the prevailing rate of inflation and this has undoubtedly made a significant difference. However, the impact is clearly plateauing and there is evidence that in the poorest communities in particular the rise of the black market in cigarettes could be acting as block on further smoking reduction.
	Increasingly, non-economic measures need to be introduced to further limit the habit, the most obvious being the ban on smoking in public places. It was not without controversy when introduced, but with Scotland taking the lead it has transformed our communities, reducing overall smoking levels. It has been of benefit to workers and non-smokers alike, but if we are honest the smoking ban has also led to more people switching their drinking, and in turn smoking, habits to a domestic setting, rather than necessarily quitting.
	Cessation services via GPs and local councils have become better organised and more comprehensive. The Local Government Association in England is producing a new report this weekend on cessation services, but has informed me that councils are committed to spending over £140 million in England on cessation services this year, and this is undoubtedly a sound investment.
	The Government are to be commended on taking forward the legislation introduced by the previous Labour Government to prohibit the display of tobacco products at the point of sale, with all shops being subject to the ban by April this year. This, along with the ban on public advertising, has helped to change perspectives about the normality of smoking.
	We know that children and young teenagers can be influenced by a complex range of factors and we must do more to protect them against the harm that smoking brings. Attractive colours and packaging have a strong influence on young people, and tobacco companies have not been slow to find other, indirect ways of promoting their products. In a presentation to an industry conference back in 2006, Imperial Tobacco’s then global brand director, Geoff Good, acknowledged that the tobacco advertising ban had
	“effectively banned us from promoting all tobacco products”,
	but noted that
	“the marketing team have to become more creative…We therefore decided to look at pack design.”
	In fact, the industry was even happy to admit this in its response to the Government’s consultation on the future of tobacco controls. Philip Morris stated in its response that
	“packaging is an important means…of communicating to consumers about what brands are on sale and in particular the goodwill associated with our trademarks, indicating brand value and quality…placing trademarks on packaged goods is thus at the heart of commercial expression”.
	I struggle to imagine what the good will of a cigarette might actually amount to, but there is no doubt that the industry has exerted enormous pressure to stop this move.
	It is no coincidence that the colours and graphics used on these packs are designed to attract new and younger users, and research shows that this increased emphasis has had an effect. Between 2002 and 2006, there was an increase in the proportion of young people aware of new pack design from 11% in 2002 to 18% in 2006. As the Minister is well aware, the systematic review commissioned by her own Government of 37 different studies provided evidence of the impacts of plain packaging. Each of the 19 studies that examined perceptions of attractiveness found that standard plain packets were rated as less attractive than branded packs. The studies also showed that the awareness of health risks was higher with standard packaging. Younger respondents were more likely to perceive that standard packs would discourage the take-up of smoking. All those findings back up the case that such a change would have an impact on young teenagers who were tempted to smoke.
	In Australia, where plain packaging legislation was introduced in 2012, smoking rates have fallen dramatically. Daily smoking levels are at an historic low of 12.8%, and the average number of cigarettes smoked is now just 96 per week, compared with 111 in 2010. Fewer young people in Australia are trying cigarettes, and
	those who do so start at a higher age than in the past. Opposition to plain packaging among the public has also fallen steeply since the legislation came into force.
	Some have argued that such a move will open the doors to a massive black market, and I note that that allegation has been reported in The Daily Telegraph in the past week. However, the main driver of black markets is economic: the difference between the actual value of the good and the price set for the consumer. It should not be beyond the wit of the authorities to devise a form of unique marking to stem counterfeit products. As the Minister will be aware, Sir Cyril Chantler stated in his report last year that he had found
	“no convincing evidence to suggest that standardised packaging would increase the illicit market”.
	The Trading Standards Institute has helpfully advised me today that, having reviewed the proposed regulations, it understands that standardised packs will retain the same security features as those found on existing tobacco packaging. It is the institute’s professional view that standardised packs would provide no new challenges in terms of detecting illicit products.
	We know from what has occurred in Australia that tobacco companies have been forceful in pursuing their opposition at every step of the way. On the day that the Australian Government passed their legislation, Philip Morris and a number of other producers immediately launched a lawsuit to challenge the law. That challenge was rejected by the Australian domestic courts in 2012, but Philip Morris was not prepared to give up. In addition to taking the domestic action, it rearranged its assets in order to become a Hong Kong investor and use the 1993 bilateral trade agreement between the two countries to initiate an investor dispute arbitration. That case is due to be heard next month in Singapore, behind closed doors.
	In addition, the company helped to finance a separate World Trade Organisation action brought against Australia by five tobacco-producing states. Australia refused each of those countries’ first requests, as allowed under WTO rules, but Ukraine made a second request in September 2012, which led to the establishment and composition of a dispute panel. The panel was composed in May 2014, but no report has been adopted and this matter is still outstanding. Similar industry pressure in New Zealand led by British American Tobacco has led to a long postponement, despite the fact that the legislation was introduced in its Parliament more than a year ago.
	Using the same ISDS dispute procedure that the UK Government are so keen to support in the current EU-US negotiations on the Transatlantic Trade and Investment Partnership—TTIP—Philip Morris is suing tiny Uruguay over its decision to increase the size of health warnings on cigarette packets from 50% of the cover to 80%. We now await the outcome of this David and Goliath struggle, but it does raise the question as to why our Government are not more questioning of the possible impact of investor-state dispute settlement clauses on our public health policy, given the lengths that the tobacco industry is clearly prepared to take.
	We need the UK to be brave—to face up to the industry giants and act in the interests of the public we serve. The Minister will be aware that the Scottish Government have sensibly agreed that legislation should be brought in throughout the UK at the same time and
	have given their assent to regulations being brought in by this Government covering Scotland, too. I want her assurance tonight that she will act on this agreement to give the boost to public health that is so needed in my city.
	Over the past few years there have been several well-supported public campaigns calling on MPs to act, and recent polling has shown that a majority of the public are in favour of this proposal.

George Young: The hon. Lady will be aware that a range of views may be held among Government Members, but may I assure her that within my party there is a strong body of opinion supporting what she is saying and joining her in urging the Government to take action?

Ann McKechin: I am grateful to the right hon. Gentleman for his support tonight. This matter should, I hope, elicit cross-party support, because the health of our young people is a key issue that all of us should be deeply concerned about.

Mark Lazarowicz: I am grateful to my hon. Friend for making a powerful speech tonight. May I take her back to an earlier point at the beginning of her speech and highlight the fact that if this measure is not introduced by the Government soon, it will be delayed until probably after the summer, as a result of which, indirectly, thousands of lives will be lost?

Ann McKechin: Yes. As I have said before, half those who take up smoking will not be able to stop, and we know that every week hundreds of teenagers across the UK take up the smoking habit. So every week that we delay has a direct health impact in our local communities.
	The Minister’s own review, the Chantler review, concluded when it reported in early April last year that branded packaging plays an important role in encouraging young people to smoke and in consolidating the habit, irrespective of the intentions of the tobacco industry and that the body of evidence showed that plain packaging is very likely to lead to a modest but important reduction over time on the take-up and prevalence of smoking. The Minister is already on the public record as accepting that standardised packaging is
	“very likely to have a positive impact on public health”—[Official Report, 3 April 2014; Vol. 578, c. 1018.]
	and as wanting to proceed as swiftly as possible. I have no reason to doubt her intentions, but time is running out.
	The Prime Minister must allow Parliament to vote on plain packaging regulations before the election. He must heed the advice of health professionals, 4,000 of whom signed an open letter to The Guardian demanding urgent action, and ignore the protestations of his Australian spin doctor Lynton Crosby, whose tobacco industry links are said to have scuppered the push for plain packaging in 2012 when the Government pushed the issue into the long grass. Too many people are needlessly dying prematurely because of smoking and too many young people are still being hooked.

Paul Burstow: This is a very important debate. As the chair of the all-party group on smoking and health, may I say to the hon. Lady that what we need to hear from the Minister tonight is that the Government write-around has started and that the regulations will be laid, so that we can have a vote?

Ann McKechin: The right hon. Gentleman is right about that, because these regulations, which need to be laid by the end of this month if they are to be approved in time by the Joint Committee on Statutory Instruments and the Secondary Legislation Scrutiny Committee. That is why we need to use the precious time that we have in this Parliament between now and the end of March to save lives and reduce the burden on the national health service. I hope the Prime Minister, his Government and the Minister who responds will listen to that call and start to act on behalf of everyone.

Angela Watkinson: I draw Members’ attention to my entry in the Register of Members’ Financial Interests. I thank the hon. Member for Glasgow North (Ann McKechin) for allowing me to make a brief contribution during her debate—doubly so, because she did not withdraw her permission when I told her that I was going to disagree with her. Similarly, I thank the Minister.
	I speak as a lifelong non-smoker. That is my choice, and it is a choice open to everybody. Nobody is forced to smoke. The Government have already invested heavily in existing strategies: television adverts, which were extremely effective—particularly the one about not smoking in front of children in one’s car—street hoardings, newspapers and magazines, smoking cessation treatment free of charge in GP surgeries and pharmacies, and anti-smoking advice in schools. My own schools are very effective in giving citizenship classes warning about the health risks of smoking. There cannot be anyone in this country, young or old, who does not know about the health risks of tobacco. Nobody smokes in ignorance.
	Plain packaging has the laudable purpose of deterring children from starting smoking and helping smokers who wish to quit, but there is no reliable evidence that plain packaging will influence smokers in general or children in particular. In Australia, where plain packaging was introduced in 2012, both youth smoking and sales of illicit tobacco increased in the following year. There are many complex social reasons that lead to youth smoking, but packaging is not one of those factors. Currently 3% of under-15s smoke in the United Kingdom—the lowest percentage in a generation. I have asked people who were buying cigarettes in my local newsagent whether plain packaging would influence their tobacco purchasing habits, and they find the idea laughable.
	Standardised packaging would be bad for exports, bad for retailers, particularly small shops, bad for jobs in warehousing, distribution, marketing, design and packaging, and bad for the Treasury, but very good for criminals, making the illicit trade much easier. What would follow—bottles of wine with plain labels, or bars of chocolate in plain packages as we are controlled and someone else makes our decisions for us?
	Let us try to be positive and sensible. Let us clamp down on illicit sales of smuggled cigarettes in our neighbourhoods, and enforce a new ban on purchasing tobacco for under-18s, as with alcohol. Let us support shopkeepers in their role as gatekeepers to age-restricted products, encourage “No ID, no sale” signs in shop windows, and enforce stiff penalties against retailers—

Eleanor Laing: Order. I hesitate to interrupt the hon. Lady, but time is very short. I hope she will draw her remarks to a close because the Minister has a speech to make.

Angela Watkinson: I am very aware of that, Madam Deputy Speaker.
	Let us enforce stiff penalties against retailers caught selling cigarettes knowingly to children and let us not forget the responsibility of parents to know how much pocket money their children have to spend and what they spend it on. In short, the policy of plain packaging is well intentioned but misguided. It will do more harm than good. It will not work and I oppose it.

Jane Ellison: I am pleased to have the opportunity to respond to this important debate and I congratulate the hon. Member for Glasgow North (Ann McKechin) on securing it.
	As other Members have said, tobacco use remains one of our most significant public health challenges and reducing smoking rates is a key public health priority for this Government. The burden of smoking places enormous strain on the NHS and holds us back in the battle against cancer. This is why the Government have committed to and delivered on a comprehensive set of tobacco control measures, which include a ban on smoking in cars with children present, making it illegal for adults to buy tobacco products on behalf of children, outlawing displaying tobacco in shops and working to introduce age of sale requirements for e-cigarettes. Standardised packaging is part of this strategy and I am grateful for tonight’s opportunity to provide the House with an update on this policy.
	It is important to acknowledge the enormous progress that has been made so far. Smoking rates in England are at their lowest level since records began. Today, around 18% of adults are smokers, down from around half of adults in the 1970s. Almost 2 million fewer people in England are smokers compared with a decade ago. Assuming that the downward trend of the past years continues, that equates to around 15,000 smoking-related deaths avoided during the course of this Parliament.
	We know that most smokers start young, and we want our children to grow up free from the burden of disease that tobacco inflicts. The very good news is that the rates of regular smoking by children in England are also falling, with 8% of 15-year-olds smoking now compared with 15% in 2009, achieving the target set out in our tobacco control plan two years early. However, around 8 million people in England still smoke, so there is no room for complacency. The hon. Member for Glasgow North is right to draw attention to regional differences in smoking rates—including in her own area,
	where more than one in four people smokes. I think that she will agree with me that there is a concerning link between those rates and deprivation.
	I wish to pick up on what the hon. Lady said about prevarication and delay. I have always been clear about the need to follow a robust process and ensure that all issues relevant to the introduction of standardised packaging are properly considered. That includes the implications for illicit trade, as my hon. Friend the Member for Hornchurch and Upminster (Dame Angela Watkinson) mentioned, as well as the legal issues.

Nick de Bois: Will my hon. Friend give way on that point?

Jane Ellison: I am afraid that I am really short of time.

Nick de Bois: Just a brief question.

Jane Ellison: I am very sorry, but I have been left very short of time.
	The challenges that the tobacco industry is likely to bring to the regulations have also been carefully considered. It is vital that all stakeholders are heard and all evidence is carefully considered and evaluated. Ministers must ensure that that is done as thoroughly as possible so that any decision taken is solidly based on the available evidence.
	Over the past few weeks and months, the Department of Health has carefully considered all responses to the most recent consultation and taken into account all the information and evidence on the public health implications as well as the wider issues, including the legal ones. I commend my officials, who have worked tirelessly to provide me and my ministerial colleagues with essential and valuable advice with which to make a decision.
	As the House has already heard, I asked Sir Cyril Chantler, an eminent paediatrician, to undertake an independent review of whether the introduction of standardised packaging is likely to have an effect on public health, in particular in relation to children. I would like to thank him again for delivering such a thorough report.
	Sir Cyril’s report concludes that, if standardised packaging were introduced, it would very likely have a positive impact on public health and that the health benefits would include health benefits for children. Following the publication of his report, we also held a final short consultation in summer 2014, seeking new and additional information, relevant to the policy, that had arisen since the last consultation.
	Earlier this month, the chief medical officer and chief scientific adviser, Professor Dame Sally Davies, provided me with her review of the evidence and also of the criticisms of the Chantler review that have been put forward by the tobacco industry. Dame Sally has made it clear that she
	“does not believe there is evidence to show that the process or the conclusions of the Chantler review are flawed and there is now accumulating evidence to support the conclusions of the review.”
	It is her view that the evidence does support the introduction of standardised packaging.
	There have been particular concerns that standardised packaging would increase illicit trade. In his review, Sir Cyril addresses those concerns and concludes:
	“I am not convinced by the tobacco industry’s argument that standardised packaging would increase the illicit market, especially in counterfeit cigarettes.”
	Her Majesty’s Revenue and Customs has also undertaken a detailed assessment of the potential impact of standardised packaging on the illicit market. It concluded:
	“We have seen no evidence to suggest the introduction of standardised packaging will have a significant impact on the overall size of the illicit market or prompt a step-change in the activity of organised crime groups.”
	The assessment is expected to be published in full soon.
	We are also giving careful consideration to any and all potential legal challenges that may be brought against the Government as a result of introducing standardised packaging. As the hon. Lady knows, litigation by the tobacco industry is always a risk when introducing tobacco control legislation.
	The Government are committed to reducing the numbers of young people taking up smoking and to helping smokers who are trying to quit. Our comprehensive approach to tobacco control is working. Fewer people than ever now smoke and cancer survival rates are at record highs. However, we cannot be complacent. We all know the damage that smoking does to health. Tobacco causes over 80,000 deaths a year, and around 600 children in the UK start smoking every day, as the hon. Member for Glasgow North said in her opening remarks.
	The Government are completely committed to protecting children from the harm that tobacco causes. That is why I am announcing today that we will be bringing forward legislation for standardised packaging before the end of this Parliament. A consultant respiratory physician told me last year that he is confident that the introduction of standardised packaging will end up saving more lives than he would be able to in his entire career.
	I thank all the people who have campaigned for this policy and all those who have contributed to the consultations—the 2012 consultation and the 2014 consultation. I hope that the thousands of other clinicians who have written to me, and to colleagues, over the past weeks and months will welcome this important progress. I want to reassure the House that I will provide further details about the introduction of the policy in due course.
	Legislation—even new laws on packaging—will not solve all the problems relating to tobacco. Effective tobacco control depends not just on Government action; local authorities also have a key role, which is why we gave local government responsibility for public health. It is best placed to take forward local plans, based on local circumstances. We see a wide variation between the levels of smoking in our nation—during pregnancy and among young people—and we see that the policy of local action has been vindicated. Local authorities, supported by Public Health England, can advise on effective local action and share experience of what works.
	Standardised packaging has the potential for huge public health benefits, but we must not forget that other measures will also contribute to reducing smoking rates. I remind the hon. Member for Glasgow North that Sir Cyril Chantler’s report advises that any policy
	of standardised packaging must be seen in the round as part of a comprehensive policy of tobacco control measures, and that is how I see the potential for standardised packaging working in this country. Effective tobacco control depends on taking a multifaceted approach, and that is what we are doing.
	Only this morning, I was speaking to a number of local government leaders and hearing their reflections, and I know that many local authorities as well as health charities have also addressed the Government on this subject. Legislation to end tobacco displays has already been implemented for large shops such as supermarkets, as I mentioned. All other shops selling tobacco, including corner shops, will need to end their displays of tobacco on 6 April. The display of tobacco products in shops can promote smoking by young people and undermine the resolve of adult smokers trying to quit—and we know how many adult smokers are trying to quit.
	While I have the Floor, I can give the House an update on smoking in cars. We laid the regulations to end smoking in private vehicles carrying children on 17 December 2014. The regulations have been considered by the scrutiny Committees, and I expect that we shall have a date for the debate soon. The regulations make it an offence to smoke in a vehicle if a child is present, and for a driver to fail to stop someone smoking in such situations. They provide for the police to be able to enforce against these offences and, if approved by Parliament, the regulations will come into force on 1 October 2015—again, as part of a comprehensive tobacco control strategy. We will also continue social marketing work in this area, with Public Health England running campaigns to raise awareness of the health harms and of the new offences. It is not my desire that people should be fined as a result of ignorance, and I want to ensure that as many people as possible are aware of the new policy.
	As I mentioned earlier, we have also introduced legislation to make it illegal for an adult to buy or attempt to buy tobacco for anyone under the age of 18. Through regulations we plan to extend the scope of this offence to cover e-cigarettes. The Department is currently consulting on those draft regulations to introduce age-of-sale requirements for electronic cigarettes, as we already have for tobacco, and that consultation will close on 28 January.
	I thank colleagues who have attended the debate, many of whom have expressed strong views about this policy. All of those views have been extremely carefully considered. The hon. Member for Glasgow North referred to the desire to make UK-wide legislation. I can confirm that I will be speaking to my ministerial colleagues in the devolved Administrations and I hope they will follow us to make this a UK-wide measure.
	We will bring the regulations before Parliament in this Parliament. Should Parliament support the measure, we will be bringing the prospect of this country’s first smoke-free generation one decisive step closer. I thank the House for its attention tonight and colleagues for all their input into this policy making. I commend the policy to the House.
	Question put and agreed to.
	House adjourned.